Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $181.97 / $537.03	Facility	26	$93.33	$181.97	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $426.58 / $1,230.27	Professional		$199.53	$426.58	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $125.89 / $323.59	Professional	26	$67.61	$125.89	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $257.04 / $616.60	Professional	TC	$123.03	$257.04	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $147.91 / $173.78	Professional		$125.89	$147.91	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $131.83	Professional	26	$52.48	$66.07	$131.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $141.25 / $199.53	Professional	TC	$112.20	$141.25	$199.53
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $239.88 / $1,174.90	Professional		$114.82	$239.88	$1,174.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $398.11 / $794.33	Professional		$165.96	$398.11	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $93.33 / $158.49	Professional	26	$51.29	$93.33	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $281.84 / $645.65	Professional	TC	$109.65	$281.84	$645.65
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $269.15 / $1,288.25	Professional		$229.09	$269.15	$1,288.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $1,288.25	Professional	26	$79.43	$93.33	$1,288.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $177.83 / $1,288.25	Professional	TC	$147.91	$177.83	$1,288.25
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $218.78 / $467.74	Professional		$186.21	$218.78	$467.74
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $123.03	Professional	26	$60.26	$70.79	$123.03
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $302.00	Professional	TC	$125.89	$147.91	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $588.84	Professional		$165.96	$295.12	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $147.91	Professional	26	$56.23	$79.43	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $478.63	Professional	TC	$109.65	$190.55	$478.63