Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.37 / $119.21 / $518.49	Facility	26	$94.37	$119.21	$518.49
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $66.68 / $109.75 / $349.77	Facility	53	$66.68	$109.75	$349.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $202.14 / $425.00 / $638.00	Professional		$202.14	$425.00	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.48 / $117.69 / $215.00	Professional	26	$69.48	$117.69	$215.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $101.07 / $201.04 / $282.50	Professional	52	$101.07	$201.04	$282.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.25 / $282.87 / $422.10	Professional	TC	$131.25	$282.87	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $137.00 / $171.64 / $199.99	Professional		$137.00	$171.64	$199.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.70 / $61.30 / $128.40	Professional	26	$51.70	$61.30	$128.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $90.24 / $90.24 / $90.24	Professional	TC	$90.24	$90.24	$90.24
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $243.95 / $1,072.50	Professional		$111.00	$243.95	$1,072.50
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $82.27 / $122.26 / $207.66	Professional	26	$82.27	$122.26	$207.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.77 / $48.77 / $48.77	Facility	26	$48.77	$48.77	$48.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.93 / $414.86 / $839.00	Professional		$171.93	$414.86	$839.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $88.37 / $148.02	Professional	26	$49.90	$88.37	$148.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.41 / $336.34 / $752.00	Professional	TC	$114.41	$336.34	$752.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $232.69 / $308.35 / $1,318.46	Professional		$232.69	$308.35	$1,318.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.45 / $91.71 / $1,179.31	Professional	26	$78.45	$91.71	$1,179.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $153.59 / $184.70 / $1,179.31	Professional	TC	$153.59	$184.70	$1,179.31
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.21 / $217.89 / $624.11	Professional		$185.21	$217.89	$624.11
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.32 / $69.79 / $111.00	Professional	26	$59.32	$69.79	$111.00
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $148.10 / $261.30	Professional	TC	$125.89	$148.10	$261.30
United Facility/Professional Professional Modifier Low / Median / High Price $165.46 / $294.63 / $568.41	Professional		$165.46	$294.63	$568.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.64 / $76.15 / $138.75	Professional	26	$58.64	$76.15	$138.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.83 / $181.80 / $435.47	Professional	TC	$105.83	$181.80	$435.47