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 $197.92 / $405.77 / $646.00	Professional		$197.92	$405.77	$646.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $118.59 / $214.44	Professional	26	$70.73	$118.59	$214.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.96 / $201.04 / $267.35	Professional	52	$98.96	$201.04	$267.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.17 / $282.87 / $433.05	Professional	TC	$125.17	$282.87	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.96 / $145.43 / $194.43	Professional		$126.96	$145.43	$194.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $58.77 / $129.66	Professional	26	$51.59	$58.77	$129.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $86.30 / $86.30	Professional	TC	$86.30	$86.30	$86.30
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $194.39 / $391.00 / $1,119.27	Professional		$194.39	$391.00	$1,119.27
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $128.43 / $220.06	Professional	26	$73.73	$128.43	$220.06
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 $165.96 / $400.00 / $856.49	Professional		$165.96	$400.00	$856.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.14 / $88.81 / $148.72	Professional	26	$50.14	$88.81	$148.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.40 / $306.30 / $708.72	Professional	TC	$109.40	$306.30	$708.72
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $226.39 / $299.92 / $1,287.10	Professional		$226.39	$299.92	$1,287.10
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $92.18 / $1,290.72	Professional	26	$78.86	$92.18	$1,290.72
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.91 / $176.64 / $1,290.72	Professional	TC	$146.91	$176.64	$1,290.72
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.42 / $212.26 / $532.99	Professional		$180.42	$212.26	$532.99
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 $121.10 / $142.47 / $247.53	Professional	TC	$121.10	$142.47	$247.53
United Facility/Professional Professional Modifier Low / Median / High Price $172.22 / $309.22 / $549.30	Professional		$172.22	$309.22	$549.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.64 / $81.96 / $139.34	Professional	26	$58.64	$81.96	$139.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.17 / $188.13 / $464.32	Professional	TC	$110.17	$188.13	$464.32