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 $364.31 / $475.00 / $1,111.50	Professional		$364.31	$475.00	$1,111.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.18 / $126.00 / $189.46	Professional	26	$99.18	$126.00	$189.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $261.45 / $330.93 / $589.57	Professional	TC	$261.45	$330.93	$589.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.30 / $307.87 / $420.20	Professional		$134.30	$307.87	$420.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.22 / $81.88 / $123.57	Professional	26	$75.22	$81.88	$123.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $407.83 / $407.83 / $407.83	Professional	TC	$407.83	$407.83	$407.83
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $110.09 / $229.45 / $229.45	Professional		$110.09	$229.45	$229.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.73 / $70.73 / $70.73	Facility	26	$70.73	$70.73	$70.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $362.74 / $784.90 / $1,476.00	Professional		$362.74	$784.90	$1,476.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $127.32 / $213.48	Professional	26	$72.33	$127.32	$213.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.45 / $637.91 / $1,270.14	Professional	TC	$287.45	$637.91	$1,270.14
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $485.50 / $645.54 / $2,213.21	Professional		$485.50	$645.54	$2,213.21
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $115.41 / $134.46 / $184.40	Professional	26	$115.41	$134.46	$184.40
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $369.36 / $444.28 / $602.27	Professional	TC	$369.36	$444.28	$602.27
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.85 / $471.54 / $762.69	Professional		$389.85	$471.54	$762.69
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.55 / $100.65 / $141.21	Professional	26	$85.55	$100.65	$141.21
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $315.26 / $370.89 / $642.65	Professional	TC	$315.26	$370.89	$642.65
United Facility/Professional Professional Modifier Low / Median / High Price $367.68 / $650.40 / $1,095.24	Professional		$367.68	$650.40	$1,095.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.39 / $117.89 / $193.89	Professional	26	$85.39	$117.89	$193.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $284.63 / $470.52 / $888.41	Professional	TC	$284.63	$470.52	$888.41