Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.00 / $61.10 / $206.37	Facility	26	$47.00	$61.10	$206.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.97 / $187.52 / $401.00	Professional		$118.97	$187.52	$401.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $52.08 / $124.49	Professional	26	$45.76	$52.08	$124.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.47 / $88.10 / $140.38	Professional	52	$64.47	$88.10	$140.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.87 / $131.69 / $269.70	Professional	TC	$81.87	$131.69	$269.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.80 / $108.86 / $135.12	Professional		$92.80	$108.86	$135.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.54 / $44.27 / $84.08	Professional	26	$37.54	$44.27	$84.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.34 / $110.00 / $110.00	Professional	TC	$37.34	$110.00	$110.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $74.73 / $161.97 / $600.00	Professional		$74.73	$161.97	$600.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $53.62 / $100.82 / $149.54	Professional	26	$53.62	$100.82	$149.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.97 / $37.97 / $37.97	Facility	26	$37.97	$37.97	$37.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.97 / $278.93 / $473.00	Professional		$124.97	$278.93	$473.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.38 / $65.59 / $111.76	Professional	26	$36.38	$65.59	$111.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.47 / $204.78 / $349.23	Professional	TC	$88.47	$204.78	$349.23
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $157.41 / $208.34 / $675.73	Professional		$157.41	$208.34	$675.73
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.32 / $67.03 / $561.66	Professional	26	$57.32	$67.03	$561.66
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.62 / $119.84 / $561.66	Professional	TC	$99.62	$119.84	$561.66
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $130.99 / $154.10 / $308.30	Professional		$130.99	$154.10	$308.30
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.15 / $54.29 / $95.78	Professional	26	$46.15	$54.29	$95.78
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $84.85 / $99.82 / $179.84	Professional	TC	$84.85	$99.82	$179.84
United Facility/Professional Professional Modifier Low / Median / High Price $130.97 / $212.56 / $352.46	Professional		$130.97	$212.56	$352.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.47 / $65.11 / $103.68	Professional	26	$39.47	$65.11	$103.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.44 / $128.07 / $238.31	Professional	TC	$70.44	$128.07	$238.31