Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $189.15 / $189.16 / $213.95	Facility	26	$189.15	$189.16	$213.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $572.95 / $727.40 / $1,052.07	Professional		$572.95	$727.40	$1,052.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.16 / $130.50 / $189.16	Professional	26	$108.16	$130.50	$189.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $336.16 / $480.85	Professional	52	$258.77	$336.16	$480.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $455.27 / $571.87 / $822.51	Professional	TC	$455.27	$571.87	$822.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $596.83 / $773.40 / $773.40	Professional		$596.83	$773.40	$773.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $114.68 / $115.01 / $115.01	Professional	26	$114.68	$115.01	$115.01
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $160.46 / $181.17 / $602.52	Professional		$160.46	$181.17	$602.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $503.69 / $992.56 / $1,793.77	Professional		$503.69	$992.56	$1,793.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.46 / $182.99 / $322.87	Professional	26	$89.46	$182.99	$322.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $414.23 / $799.67 / $1,469.60	Professional	TC	$414.23	$799.67	$1,469.60
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $600.00 / $997.15 / $1,102.48	Professional		$600.00	$997.15	$1,102.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $136.10 / $174.99 / $227.43	Professional	26	$136.10	$174.99	$227.43
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $639.46 / $834.15 / $1,086.16	Professional	TC	$639.46	$834.15	$1,086.16
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $510.54 / $628.17 / $1,119.45	Professional		$510.54	$628.17	$1,119.45
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.01 / $115.67 / $361.05	Professional	26	$96.01	$115.67	$361.05
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $414.52 / $512.50 / $908.18	Professional	TC	$414.52	$512.50	$908.18
United Facility/Professional Professional Modifier Low / Median / High Price $519.01 / $754.14 / $1,437.23	Professional		$519.01	$754.14	$1,437.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $94.43 / $140.97 / $264.64	Professional	26	$94.43	$140.97	$264.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $408.37 / $617.48 / $1,172.58	Professional	TC	$408.37	$617.48	$1,172.58