Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.20 / $148.66 / $1,600.00	Facility	26	$119.20	$148.66	$1,600.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $326.61 / $475.00 / $1,102.00	Professional		$326.61	$475.00	$1,102.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.69 / $127.88 / $313.83	Professional	26	$105.69	$127.88	$313.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $163.31 / $212.50 / $300.00	Professional	52	$163.31	$212.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $216.62 / $299.00 / $479.44	Professional	TC	$216.62	$299.00	$479.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $222.56 / $279.83 / $325.04	Professional		$222.56	$279.83	$325.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.92 / $94.99 / $199.92	Professional	26	$79.92	$94.99	$199.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.74 / $149.74 / $190.92	Professional	TC	$149.74	$149.74	$190.92
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $195.57 / $543.47 / $2,090.17	Professional		$195.57	$543.47	$2,090.17
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $125.66 / $205.48 / $347.70	Professional	26	$125.66	$205.48	$347.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.68 / $77.68 / $77.68	Facility	26	$77.68	$77.68	$77.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $282.95 / $647.37 / $1,469.81	Professional		$282.95	$647.37	$1,469.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.95 / $137.36 / $228.22	Professional	26	$76.95	$137.36	$228.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.42 / $466.49 / $1,245.45	Professional	TC	$192.42	$466.49	$1,245.45
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $378.16 / $501.77 / $2,221.21	Professional		$378.16	$501.77	$2,221.21
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $122.62 / $142.80 / $2,517.29	Professional	26	$122.62	$142.80	$2,517.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.78 / $306.43 / $2,517.29	Professional	TC	$254.78	$306.43	$2,517.29
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $303.39 / $356.94 / $844.65	Professional		$303.39	$356.94	$844.65
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.42 / $107.55 / $171.05	Professional	26	$91.42	$107.55	$171.05
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $211.98 / $249.39 / $432.57	Professional	TC	$211.98	$249.39	$432.57
United Facility/Professional Professional Modifier Low / Median / High Price $287.81 / $492.33 / $963.66	Professional		$287.81	$492.33	$963.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.87 / $117.82 / $213.52	Professional	26	$89.87	$117.82	$213.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.25 / $316.38 / $750.14	Professional	TC	$199.25	$316.38	$750.14