Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $165.96 / $537.03	Facility	26	$93.33	$165.96	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $467.74 / $1,202.26	Professional		$204.17	$467.74	$1,202.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $120.23 / $288.40	Professional	26	$67.61	$120.23	$288.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $316.23 / $512.86 / $870.96	Professional	52	$316.23	$512.86	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $257.04 / $741.31	Professional	TC	$123.03	$257.04	$741.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $316.23	Professional		$131.83	$169.82	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $128.82	Professional	26	$52.48	$66.07	$128.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $112.20 / $199.53	Professional	TC	$51.29	$112.20	$199.53
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $229.09 / $1,096.48	Professional		$75.86	$229.09	$1,096.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $398.11 / $758.58	Professional		$165.96	$398.11	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $93.33 / $158.49	Professional	26	$51.29	$93.33	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $281.84 / $588.84	Professional	TC	$109.65	$281.84	$588.84
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $269.15 / $1,202.26	Professional		$229.09	$269.15	$1,202.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $1,202.26	Professional	26	$79.43	$93.33	$1,202.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $177.83 / $1,202.26	Professional	TC	$147.91	$177.83	$1,202.26
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $218.78 / $467.74	Professional		$186.21	$218.78	$467.74
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $123.03	Professional	26	$60.26	$70.79	$123.03
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $302.00	Professional	TC	$125.89	$147.91	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $575.44	Professional		$165.96	$295.12	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $147.91	Professional	26	$56.23	$79.43	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $457.09	Professional	TC	$109.65	$190.55	$457.09