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 $290.47 / $450.76 / $638.00	Professional		$290.47	$450.76	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.48 / $119.21 / $166.95	Professional	26	$69.48	$119.21	$166.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $220.59 / $305.35 / $441.00	Professional	TC	$220.59	$305.35	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $201.20 / $278.79 / $278.79	Professional		$201.20	$278.79	$278.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.84 / $56.84 / $113.98	Professional	26	$56.84	$56.84	$113.98
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $1,100.00 / $1,100.00 / $1,100.00	Professional		$1,100.00	$1,100.00	$1,100.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.74 / $47.74 / $47.74	Facility	26	$47.74	$47.74	$47.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.30 / $566.87 / $964.33	Professional		$303.30	$566.87	$964.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.20 / $86.69 / $146.49	Professional	26	$49.20	$86.69	$146.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $250.28 / $472.75 / $824.61	Professional	TC	$250.28	$472.75	$824.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $372.89 / $495.88 / $1,392.92	Professional		$372.89	$495.88	$1,392.92
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.73 / $90.85 / $1,157.93	Professional	26	$77.73	$90.85	$1,157.93
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $294.54 / $354.29 / $1,157.93	Professional	TC	$294.54	$354.29	$1,157.93
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $253.28 / $297.98 / $547.60	Professional		$253.28	$297.98	$547.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.47 / $68.79 / $95.01	Professional	26	$58.47	$68.79	$95.01
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.81 / $229.19 / $401.06	Professional	TC	$194.81	$229.19	$401.06
United Facility/Professional Professional Modifier Low / Median / High Price $272.72 / $443.04 / $761.44	Professional		$272.72	$443.04	$761.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.85 / $80.02 / $138.41	Professional	26	$57.85	$80.02	$138.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $249.44 / $404.92 / $669.76	Professional	TC	$249.44	$404.92	$669.76