Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.33 / $119.21 / $518.49	Facility	26	$86.33	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.99 / $402.08 / $900.00	Professional		$152.99	$402.08	$900.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.41 / $119.20 / $196.00	Professional	26	$64.41	$119.20	$196.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $989.60 / $1,020.05 / $1,557.00	Professional	50	$989.60	$1,020.05	$1,557.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $104.19 / $201.04 / $262.50	Professional	52	$104.19	$201.04	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $299.00 / $441.00	Professional	TC	$142.94	$299.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.74 / $176.81 / $207.86	Professional		$141.74	$176.81	$207.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.62 / $56.22 / $120.92	Professional	26	$47.62	$56.22	$120.92
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $224.53 / $224.53 / $224.53	Professional	50	$224.53	$224.53	$224.53
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $143.00 / $437.96 / $1,056.25	Professional		$143.00	$437.96	$1,056.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $67.42 / $117.28 / $203.61	Professional	26	$67.42	$117.28	$203.61
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $67.72 / $223.34 / $725.85	Professional	50	$67.72	$223.34	$725.85
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 $175.62 / $411.36 / $831.50	Professional		$175.62	$411.36	$831.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.05 / $78.45 / $134.93	Professional	26	$46.05	$78.45	$134.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.70 / $323.30 / $729.32	Professional	TC	$120.70	$323.30	$729.32
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $241.23 / $335.74 / $1,267.18	Professional		$241.23	$335.74	$1,267.18
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 $168.61 / $202.65 / $1,138.80	Professional	TC	$168.61	$202.65	$1,138.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.49 / $224.11 / $617.08	Professional		$190.49	$224.11	$617.08
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.03 / $63.57 / $101.11	Professional	26	$54.03	$63.57	$101.11
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.46 / $160.54 / $255.33	Professional	TC	$136.46	$160.54	$255.33
United Facility/Professional Professional Modifier Low / Median / High Price $175.35 / $309.12 / $564.38	Professional		$175.35	$309.12	$564.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.95 / $73.06 / $127.57	Professional	26	$53.95	$73.06	$127.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.16 / $213.48 / $430.96	Professional	TC	$126.16	$213.48	$430.96