Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.88 / $78.12 / $239.01	Professional		$51.88	$78.12	$239.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.70 / $59.81 / $256.37	Professional	26	$28.70	$59.81	$256.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.92 / $32.49 / $52.87	Professional	52	$22.92	$32.49	$52.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $37.79 / $98.76	Professional	TC	$26.62	$37.79	$98.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.40 / $39.40 / $78.80	Professional		$39.40	$39.40	$78.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.34 / $49.52 / $62.65	Professional	26	$34.34	$49.52	$62.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $18.23 / $20.26	Professional	TC	$18.23	$18.23	$20.26
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $44.00 / $81.41 / $196.17	Professional		$44.00	$81.41	$196.17
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $38.28 / $55.61 / $79.62	Professional	26	$38.28	$55.61	$79.62
AmeriHealth Facility/Professional Professional Modifier TC Low / Median / High Price $70.84 / $70.84 / $70.84	Professional	TC	$70.84	$70.84	$70.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.70 / $72.70 / $151.19	Professional		$39.70	$72.70	$151.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.77 / $38.13 / $73.95	Professional	26	$19.77	$38.13	$73.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.23 / $39.31 / $93.16	Professional	TC	$18.23	$39.31	$93.16
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $52.90 / $82.91 / $148.32	Professional		$52.90	$82.91	$148.32
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.06 / $40.82 / $74.34	Professional	26	$26.06	$40.82	$74.34
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.83 / $42.54 / $103.82	Professional	TC	$26.83	$42.54	$103.82
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.46 / $56.66 / $150.80	Professional		$30.46	$56.66	$150.80
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.47 / $37.07 / $69.34	Professional	26	$25.47	$37.07	$69.34
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.70 / $31.08 / $98.49	Professional	TC	$22.70	$31.08	$98.49
United Facility/Professional Professional Modifier Low / Median / High Price $34.97 / $55.16 / $107.19	Professional		$34.97	$55.16	$107.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.21 / $31.81 / $53.50	Professional	26	$17.21	$31.81	$53.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.51 / $28.36 / $47.68	Professional	TC	$17.51	$28.36	$47.68