Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.35 / $34.14 / $86.12	Facility	26	$27.35	$34.14	$86.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.37 / $126.18 / $347.00	Professional		$97.37	$126.18	$347.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.35 / $33.96 / $92.70	Professional	26	$27.35	$33.96	$92.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $47.66 / $56.67 / $82.08	Professional	52	$47.66	$56.67	$82.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.04 / $89.73 / $160.32	Professional	TC	$69.04	$89.73	$160.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.38 / $104.95 / $174.33	Professional		$76.38	$104.95	$174.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.18 / $29.41 / $60.79	Professional	26	$24.18	$29.41	$60.79
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $17.52 / $21.90 / $59.46	Professional	52	$17.52	$21.90	$59.46
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $122.34 / $122.34 / $122.34	Professional	TC	$122.34	$122.34	$122.34
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $59.04 / $155.66 / $315.56	Professional		$59.04	$155.66	$315.56
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $38.07 / $57.33 / $103.01	Professional	26	$38.07	$57.33	$103.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.63 / $160.97 / $268.43	Professional		$93.63	$160.97	$268.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.89 / $43.96 / $73.50	Professional	26	$23.89	$43.96	$73.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.46 / $107.13 / $187.39	Professional	TC	$60.46	$107.13	$187.39
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $118.58 / $163.99 / $281.13	Professional		$118.58	$163.99	$281.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.72 / $43.26 / $337.59	Professional	26	$35.72	$43.26	$337.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.44 / $120.73 / $337.59	Professional	TC	$99.44	$120.73	$337.59
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.77 / $125.90 / $183.05	Professional		$102.77	$125.90	$183.05
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.58 / $33.25 / $110.98	Professional	26	$27.58	$33.25	$110.98
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.17 / $90.82 / $152.04	Professional	TC	$75.17	$90.82	$152.04
United Facility/Professional Professional Modifier Low / Median / High Price $79.70 / $125.63 / $221.61	Professional		$79.70	$125.63	$221.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.89 / $37.29 / $63.07	Professional	26	$23.89	$37.29	$63.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.49 / $92.45 / $168.96	Professional	TC	$60.49	$92.45	$168.96