Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.26 / $109.57 / $391.34	Facility	26	$78.26	$109.57	$391.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $241.23 / $386.10 / $688.48	Professional		$241.23	$386.10	$688.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.27 / $91.57 / $289.08	Professional	26	$78.27	$91.57	$289.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.21 / $291.01 / $482.95	Professional	TC	$159.21	$291.01	$482.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $185.15 / $213.55 / $288.62	Professional		$185.15	$213.55	$288.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.73 / $80.70 / $158.59	Professional	26	$63.73	$80.70	$158.59
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $177.62 / $177.62 / $177.62	Professional	TC	$177.62	$177.62	$177.62
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $92.19 / $177.45 / $710.25	Professional		$92.19	$177.45	$710.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $90.62 / $167.37 / $282.32	Professional	26	$90.62	$167.37	$282.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.76 / $477.73 / $930.89	Professional		$236.76	$477.73	$930.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.57 / $109.19 / $184.19	Professional	26	$61.57	$109.19	$184.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $167.00 / $364.84 / $695.61	Professional	TC	$167.00	$364.84	$695.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $314.83 / $417.94 / $1,275.58	Professional		$314.83	$417.94	$1,275.58
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.20 / $113.28 / $155.28	Professional	26	$97.20	$113.28	$155.28
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 $152.47 / $264.45 / $478.82	Professional		$152.47	$264.45	$478.82
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.56 / $85.36 / $126.10	Professional	26	$72.56	$85.36	$126.10
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $160.26 / $184.20 / $325.07	Professional	TC	$160.26	$184.20	$325.07
United Facility/Professional Professional Modifier Low / Median / High Price $253.96 / $429.35 / $662.19	Professional		$253.96	$429.35	$662.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.20 / $100.46 / $166.87	Professional	26	$72.20	$100.46	$166.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $159.66 / $259.02 / $470.90	Professional	TC	$159.66	$259.02	$470.90