Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.43 / $119.21 / $518.49	Facility	26	$76.43	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.72 / $425.00 / $629.00	Professional		$221.72	$425.00	$629.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.07 / $119.21 / $169.00	Professional	26	$58.07	$119.21	$169.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.90 / $299.00 / $440.00	Professional	TC	$162.90	$299.00	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.52 / $163.65 / $221.54	Professional		$162.52	$163.65	$221.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.10 / $46.33 / $116.57	Professional	26	$38.10	$46.33	$116.57
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $94.24 / $175.00 / $456.24	Professional		$94.24	$175.00	$456.24
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $66.77 / $104.66 / $168.01	Professional	26	$66.77	$104.66	$168.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.39 / $39.39 / $39.39	Facility	26	$39.39	$39.39	$39.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $250.81 / $545.84 / $914.14	Professional		$250.81	$545.84	$914.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.67 / $71.37 / $121.13	Professional	26	$40.67	$71.37	$121.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $189.35 / $442.72 / $799.80	Professional	TC	$189.35	$442.72	$799.80
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $256.06 / $340.17 / $1,357.17	Professional		$256.06	$340.17	$1,357.17
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.25 / $74.09 / $1,147.80	Professional	26	$63.25	$74.09	$1,147.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.21 / $231.09 / $1,147.80	Professional	TC	$192.21	$231.09	$1,147.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.80 / $240.94 / $504.72	Professional		$204.80	$240.94	$504.72
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.80 / $56.24 / $85.50	Professional	26	$47.80	$56.24	$85.50
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.00 / $184.71 / $429.81	Professional	TC	$157.00	$184.71	$429.81
United Facility/Professional Professional Modifier Low / Median / High Price $170.90 / $333.18 / $642.96	Professional		$170.90	$333.18	$642.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.93 / $61.35 / $107.28	Professional	26	$40.93	$61.35	$107.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $129.41 / $254.76 / $546.76	Professional	TC	$129.41	$254.76	$546.76