Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.82 / $119.21 / $518.49	Facility	26	$86.82	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.10 / $402.08 / $921.00	Professional		$149.10	$402.08	$921.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.41 / $119.21 / $177.20	Professional	26	$64.41	$119.21	$177.20
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.35 / $201.04 / $262.50	Professional	52	$104.35	$201.04	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $143.27 / $299.00 / $441.00	Professional	TC	$143.27	$299.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.97 / $163.24 / $208.22	Professional		$141.97	$163.24	$208.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $51.11 / $78.53	Professional	26	$47.50	$51.11	$78.53
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $206.01 / $478.23 / $983.74	Professional		$206.01	$478.23	$983.74
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $76.40 / $112.96 / $193.91	Professional	26	$76.40	$112.96	$193.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.19 / $44.19 / $44.19	Facility	26	$44.19	$44.19	$44.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.63 / $410.72 / $791.09	Professional		$176.63	$410.72	$791.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.22 / $81.04 / $136.27	Professional	26	$46.22	$81.04	$136.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.04 / $319.27 / $688.33	Professional	TC	$123.04	$319.27	$688.33
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $241.63 / $320.67 / $1,252.85	Professional		$241.63	$320.67	$1,252.85
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.01 / $84.28 / $1,138.80	Professional	26	$72.01	$84.28	$1,138.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $168.99 / $203.13 / $1,138.80	Professional	TC	$168.99	$203.13	$1,138.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $191.30 / $225.06 / $524.52	Professional		$191.30	$225.06	$524.52
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.85 / $64.53 / $96.77	Professional	26	$54.85	$64.53	$96.77
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.46 / $160.54 / $283.25	Professional	TC	$136.46	$160.54	$283.25
United Facility/Professional Professional Modifier Low / Median / High Price $182.33 / $311.22 / $566.71	Professional		$182.33	$311.22	$566.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.73 / $70.37 / $124.32	Professional	26	$48.73	$70.37	$124.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.28 / $214.47 / $431.49	Professional	TC	$128.28	$214.47	$431.49