Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.59 / $13.60 / $19.03	Facility	26	$13.59	$13.60	$19.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.05 / $108.70 / $176.45	Professional		$76.05	$108.70	$176.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $12.63 / $24.32	Professional	26	$11.14	$12.63	$24.32
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.93 / $46.26 / $78.65	Professional	52	$37.93	$46.26	$78.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.50 / $97.09 / $157.96	Professional	TC	$64.50	$97.09	$157.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $48.53 / $60.62 / $78.01	Professional		$48.53	$60.62	$78.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.50 / $10.45 / $14.17	Professional	26	$9.50	$10.45	$14.17
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $80.00 / $95.94	Professional		$80.00	$80.00	$95.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.37 / $132.81 / $260.33	Professional		$80.37	$132.81	$260.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $16.17 / $30.54	Professional	26	$10.11	$16.17	$30.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.45 / $114.65 / $205.07	Professional	TC	$68.45	$114.65	$205.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $95.16 / $125.74 / $260.74	Professional		$95.16	$125.74	$260.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.80 / $36.11	Professional	26	$13.18	$16.80	$36.11
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.97 / $108.94 / $224.60	Professional	TC	$81.97	$108.94	$224.60
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.55 / $98.24 / $166.80	Professional		$71.55	$98.24	$166.80
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.80 / $11.53 / $106.80	Professional	26	$9.80	$11.53	$106.80
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.74 / $72.64 / $137.87	Professional	TC	$61.74	$72.64	$137.87
United Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $97.95 / $188.37	Professional		$67.18	$97.95	$188.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.32 / $12.99 / $23.46	Professional	26	$9.32	$12.99	$23.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.32 / $88.36 / $166.22	Professional	TC	$56.32	$88.36	$166.22