Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.50 / $23.50 / $167.30	Facility	26	$23.50	$23.50	$167.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.96 / $53.46 / $111.63	Professional		$42.96	$53.46	$111.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.47 / $28.13 / $78.56	Professional	26	$22.47	$28.13	$78.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.00 / $28.12 / $285.00	Professional	52	$24.00	$28.12	$285.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.17 / $23.70 / $45.38	Professional	TC	$19.17	$23.70	$45.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.34 / $45.08 / $76.89	Professional		$34.34	$45.08	$76.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.51 / $26.70 / $47.98	Professional	26	$21.51	$26.70	$47.98
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $7.91 / $8.58 / $34.59	Professional	52	$7.91	$8.58	$34.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $31.31 / $31.31 / $40.46	Professional	TC	$31.31	$31.31	$40.46
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $41.60 / $83.30 / $156.00	Professional		$41.60	$83.30	$156.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $29.13 / $46.23 / $96.00	Professional	26	$29.13	$46.23	$96.00
AmeriHealth Facility/Professional Professional Modifier 52 Low / Median / High Price $34.06 / $60.00 / $129.60	Professional	52	$34.06	$60.00	$129.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.71 / $68.84 / $112.68	Professional		$38.71	$68.84	$112.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.86 / $36.11 / $59.73	Professional	26	$20.86	$36.11	$59.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.22 / $32.54 / $54.44	Professional	TC	$18.22	$32.54	$54.44
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $60.01 / $71.61 / $97.37	Professional		$60.01	$71.61	$97.37
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.10 / $37.49 / $51.25	Professional	26	$32.10	$37.49	$51.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.34 / $34.13 / $46.12	Professional	TC	$28.34	$34.13	$46.12
Horizon BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $46.80 / $46.80 / $46.80	Facility	26	$46.80	$46.80	$46.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.10 / $42.64 / $67.45	Professional		$33.10	$42.64	$67.45
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.60 / $24.24 / $43.16	Professional	26	$20.60	$24.24	$43.16
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $21.45 / $45.52	Professional	TC	$18.23	$21.45	$45.52
United Facility/Professional Professional Modifier Low / Median / High Price $39.06 / $61.53 / $100.65	Professional		$39.06	$61.53	$100.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.92 / $32.93 / $52.74	Professional	26	$19.92	$32.93	$52.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.07 / $28.60 / $48.89	Professional	TC	$19.07	$28.60	$48.89