Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.13 / $37.13 / $100.53	Facility	26	$37.13	$37.13	$100.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.80 / $134.79 / $331.10	Professional		$86.80	$134.79	$331.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.73 / $37.47 / $62.47	Professional	26	$30.73	$37.47	$62.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.67 / $94.39 / $151.87	Professional	TC	$73.67	$94.39	$151.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.66 / $99.26 / $126.58	Professional		$81.66	$99.26	$126.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.49 / $34.18 / $47.27	Professional	26	$28.49	$34.18	$47.27
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $22.45 / $22.45 / $22.45	Professional	52	$22.45	$22.45	$22.45
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $48.77 / $137.76 / $309.88	Professional		$48.77	$137.76	$309.88
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $66.70 / $102.40	Professional	26	$34.06	$66.70	$102.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.42 / $170.97 / $275.26	Professional		$99.42	$170.97	$275.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.20 / $48.29 / $78.63	Professional	26	$27.20	$48.29	$78.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.89 / $121.28 / $201.42	Professional	TC	$69.89	$121.28	$201.42
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $146.76 / $174.78 / $237.90	Professional		$146.76	$174.78	$237.90
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.03 / $50.26 / $86.59	Professional	26	$43.03	$50.26	$86.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.61 / $124.51 / $169.40	Professional	TC	$103.61	$124.51	$169.40
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.28 / $123.86 / $194.67	Professional		$105.28	$123.86	$194.67
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.73 / $37.01 / $124.52	Professional	26	$30.73	$37.01	$124.52
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.56 / $92.19 / $161.41	Professional	TC	$74.56	$92.19	$161.41
United Facility/Professional Professional Modifier Low / Median / High Price $97.70 / $153.28 / $251.07	Professional		$97.70	$153.28	$251.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.10 / $46.05 / $72.78	Professional	26	$28.10	$46.05	$72.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.29 / $107.21 / $179.66	Professional	TC	$66.29	$107.21	$179.66