Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.02 / $119.21 / $518.49	Facility	26	$93.02	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.82 / $425.00 / $846.00	Professional		$238.82	$425.00	$846.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.20 / $119.21 / $189.00	Professional	26	$70.20	$119.21	$189.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.33 / $212.50 / $286.82	Professional	52	$118.33	$212.50	$286.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.61 / $299.00 / $441.00	Professional	TC	$168.61	$299.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $158.80 / $173.78 / $233.45	Professional		$158.80	$173.78	$233.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.47 / $61.78 / $142.80	Professional	26	$51.47	$61.78	$142.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.97 / $112.97 / $112.97	Professional	TC	$112.97	$112.97	$112.97
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $257.58 / $491.48 / $1,100.00	Professional		$257.58	$491.48	$1,100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.05 / $48.05 / $48.05	Facility	26	$48.05	$48.05	$48.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.00 / $532.42 / $890.12	Professional		$245.00	$532.42	$890.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.44 / $86.88 / $146.59	Professional	26	$49.44	$86.88	$146.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.19 / $434.67 / $747.99	Professional	TC	$190.19	$434.67	$747.99
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $270.51 / $358.92 / $1,306.15	Professional		$270.51	$358.92	$1,306.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.73 / $90.85 / $1,159.06	Professional	26	$77.73	$90.85	$1,159.06
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.16 / $231.14 / $1,159.06	Professional	TC	$192.16	$231.14	$1,159.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $221.82 / $266.19 / $530.32	Professional		$221.82	$266.19	$530.32
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.47 / $68.79 / $103.16	Professional	26	$58.47	$68.79	$103.16
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $163.34 / $201.99 / $348.26	Professional	TC	$163.34	$201.99	$348.26
United Facility/Professional Professional Modifier Low / Median / High Price $202.03 / $375.62 / $639.32	Professional		$202.03	$375.62	$639.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.15 / $79.06 / $136.75	Professional	26	$58.15	$79.06	$136.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.86 / $257.43 / $500.60	Professional	TC	$143.86	$257.43	$500.60