Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.18 / $36.53 / $200.00	Facility	26	$35.18	$36.53	$200.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.59 / $138.38 / $348.87	Professional		$106.59	$138.38	$348.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.09 / $35.43 / $97.91	Professional	26	$29.09	$35.43	$97.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.57 / $91.50 / $622.50	Professional	52	$23.57	$91.50	$622.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.81 / $98.51 / $165.19	Professional	TC	$78.81	$98.51	$165.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.31 / $111.03 / $189.40	Professional		$83.31	$111.03	$189.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $33.90 / $66.69	Professional	26	$27.34	$33.90	$66.69
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $19.10 / $20.83 / $83.57	Professional	52	$19.10	$20.83	$83.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $120.44 / $120.44 / $120.44	Professional	TC	$120.44	$120.44	$120.44
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $51.35 / $123.78 / $297.70	Professional		$51.35	$123.78	$297.70
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $37.02 / $62.59 / $89.65	Professional	26	$37.02	$62.59	$89.65
AmeriHealth Facility/Professional Professional Modifier 52 Low / Median / High Price $42.83 / $180.00 / $200.55	Professional	52	$42.83	$180.00	$200.55
AmeriHealth Facility/Professional Professional Modifier TC Low / Median / High Price $91.48 / $218.34 / $268.91	Professional	TC	$91.48	$218.34	$268.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.96 / $175.19 / $282.58	Professional		$101.96	$175.19	$282.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.65 / $45.77 / $74.22	Professional	26	$25.65	$45.77	$74.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.84 / $128.22 / $212.82	Professional	TC	$73.84	$128.22	$212.82
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $150.16 / $178.84 / $243.00	Professional		$150.16	$178.84	$243.00
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.82 / $47.64 / $82.20	Professional	26	$40.82	$47.64	$82.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.07 / $131.21 / $198.43	Professional	TC	$109.07	$131.21	$198.43
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.78 / $115.88 / $201.59	Professional		$86.78	$115.88	$201.59
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.39 / $31.05 / $126.04	Professional	26	$26.39	$31.05	$126.04
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.09 / $86.78 / $154.88	Professional	TC	$72.09	$86.78	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $98.55 / $154.50 / $256.97	Professional		$98.55	$154.50	$256.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.22 / $43.09 / $67.79	Professional	26	$26.22	$43.09	$67.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.34 / $116.73 / $189.94	Professional	TC	$73.34	$116.73	$189.94