Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.70 / $100.40 / $218.04	Facility	26	$71.70	$100.40	$218.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.84 / $381.88 / $618.00	Professional		$236.84	$381.88	$618.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.72 / $86.37 / $185.75	Professional	26	$71.72	$86.37	$185.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.21 / $295.64 / $502.24	Professional	TC	$159.21	$295.64	$502.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $167.03 / $187.17 / $282.97	Professional		$167.03	$187.17	$282.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.81 / $69.18 / $136.08	Professional	26	$55.81	$69.18	$136.08
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $84.83 / $148.82 / $882.79	Professional		$84.83	$148.82	$882.79
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $90.68 / $143.88 / $218.44	Professional	26	$90.68	$143.88	$218.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.34 / $57.34 / $57.34	Facility	26	$57.34	$57.34	$57.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.94 / $503.34 / $956.59	Professional		$230.94	$503.34	$956.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.00 / $101.85 / $173.82	Professional	26	$59.00	$101.85	$173.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.57 / $380.98 / $782.07	Professional	TC	$164.57	$380.98	$782.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $310.54 / $411.95 / $1,439.36	Professional		$310.54	$411.95	$1,439.36
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.75 / $108.48 / $147.97	Professional	26	$92.75	$108.48	$147.97
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $217.01 / $260.94 / $354.04	Professional	TC	$217.01	$260.94	$354.04
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $222.19 / $261.39 / $480.94	Professional		$222.19	$261.39	$480.94
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.72 / $82.02 / $125.37	Professional	26	$69.72	$82.02	$125.37
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $179.38 / $451.08	Professional	TC	$152.47	$179.38	$451.08
United Facility/Professional Professional Modifier Low / Median / High Price $248.79 / $410.78 / $707.33	Professional		$248.79	$410.78	$707.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.59 / $96.25 / $170.05	Professional	26	$65.59	$96.25	$170.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.74 / $287.12 / $537.41	Professional	TC	$172.74	$287.12	$537.41