Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.20 / $119.21 / $518.49	Facility	26	$119.20	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $222.37 / $425.00 / $638.00	Professional		$222.37	$425.00	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $117.20 / $140.00	Professional	26	$57.00	$117.20	$140.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.72 / $299.00 / $433.05	Professional	TC	$164.72	$299.00	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $150.47 / $193.11 / $222.24	Professional		$150.47	$193.11	$222.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $47.48 / $117.21	Professional	26	$38.31	$47.48	$117.21
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $165.49 / $185.73 / $1,040.00	Professional		$165.49	$185.73	$1,040.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.14 / $39.14 / $39.14	Facility	26	$39.14	$39.14	$39.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.56 / $545.84 / $913.45	Professional		$251.56	$545.84	$913.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.67 / $71.48 / $120.91	Professional	26	$40.67	$71.48	$120.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.10 / $442.72 / $804.08	Professional	TC	$190.10	$442.72	$804.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $256.83 / $341.22 / $1,353.61	Professional		$256.83	$341.22	$1,353.61
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $74.56 / $1,147.80	Professional	26	$63.64	$74.56	$1,147.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.61 / $231.55 / $1,147.80	Professional	TC	$192.61	$231.55	$1,147.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $205.71 / $242.01 / $513.19	Professional		$205.71	$242.01	$513.19
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.10 / $56.59 / $84.87	Professional	26	$48.10	$56.59	$84.87
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.60 / $185.41 / $327.14	Professional	TC	$157.60	$185.41	$327.14
United Facility/Professional Professional Modifier Low / Median / High Price $171.43 / $333.80 / $628.69	Professional		$171.43	$333.80	$628.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.76 / $65.05 / $107.96	Professional	26	$41.76	$65.05	$107.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.85 / $255.74 / $554.11	Professional	TC	$130.85	$255.74	$554.11