Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $176.06 / $176.06 / $206.26	Facility	26	$176.06	$176.06	$206.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $547.67 / $679.75 / $1,007.87	Professional		$547.67	$679.75	$1,007.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.86 / $129.72 / $244.72	Professional	26	$103.86	$129.72	$244.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $247.60 / $320.37 / $436.24	Professional	52	$247.60	$320.37	$436.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $434.27 / $539.58 / $792.54	Professional	TC	$434.27	$539.58	$792.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $538.78 / $538.78 / $569.91	Professional		$538.78	$538.78	$569.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $109.95 / $128.57 / $190.19	Professional	26	$109.95	$128.57	$190.19
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $125.44 / $125.44 / $582.92	Professional		$125.44	$125.44	$582.92
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $104.08 / $138.37 / $341.89	Professional	26	$104.08	$138.37	$341.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $482.45 / $924.41 / $1,703.07	Professional		$482.45	$924.41	$1,703.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.24 / $175.88 / $307.27	Professional	26	$86.24	$175.88	$307.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $396.21 / $749.72 / $1,381.17	Professional	TC	$396.21	$749.72	$1,381.17
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $512.59 / $951.84 / $1,052.56	Professional		$512.59	$951.84	$1,052.56
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.18 / $167.76 / $217.31	Professional	26	$130.18	$167.76	$217.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $610.16 / $795.72 / $1,036.46	Professional	TC	$610.16	$795.72	$1,036.46
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $488.60 / $601.16 / $1,063.08	Professional		$488.60	$601.16	$1,063.08
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $92.52 / $111.47 / $296.22	Professional	26	$92.52	$111.47	$296.22
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $396.08 / $489.69 / $851.23	Professional	TC	$396.08	$489.69	$851.23
United Facility/Professional Professional Modifier Low / Median / High Price $514.77 / $717.34 / $1,319.34	Professional		$514.77	$717.34	$1,319.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.28 / $135.60 / $262.12	Professional	26	$86.28	$135.60	$262.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $409.27 / $589.99 / $1,120.39	Professional	TC	$409.27	$589.99	$1,120.39