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 Professional Modifier Low / Median / High Price $197.59 / $404.13 / $638.00	Professional		$197.59	$404.13	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.65 / $118.59 / $200.20	Professional	26	$70.65	$118.59	$200.20
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.80 / $201.04 / $261.69	Professional	52	$98.80	$201.04	$261.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.54 / $282.87 / $422.10	Professional	TC	$124.54	$282.87	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $96.87 / $144.61 / $193.73	Professional		$96.87	$144.61	$193.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $65.67 / $114.59	Professional	26	$51.59	$65.67	$114.59
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $204.32 / $373.22 / $1,088.75	Professional		$204.32	$373.22	$1,088.75
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $82.71 / $128.43 / $225.40	Professional	26	$82.71	$128.43	$225.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.55 / $52.55 / $52.55	Facility	26	$52.55	$52.55	$52.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.77 / $400.00 / $790.26	Professional		$166.77	$400.00	$790.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.14 / $91.59 / $154.03	Professional	26	$50.14	$91.59	$154.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.43 / $309.27 / $669.12	Professional	TC	$109.43	$309.27	$669.12
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $225.61 / $298.88 / $1,240.34	Professional		$225.61	$298.88	$1,240.34
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $92.18 / $1,191.69	Professional	26	$78.86	$92.18	$1,191.69
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.11 / $175.70 / $1,191.69	Professional	TC	$146.11	$175.70	$1,191.69
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.12 / $211.91 / $388.35	Professional		$180.12	$211.91	$388.35
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 $120.79 / $142.11 / $250.74	Professional	TC	$120.79	$142.11	$250.74
United Facility/Professional Professional Modifier Low / Median / High Price $182.31 / $308.70 / $552.65	Professional		$182.31	$308.70	$552.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $80.22 / $139.33	Professional	26	$56.28	$80.22	$139.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.89 / $182.43 / $412.30	Professional	TC	$109.89	$182.43	$412.30