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 $297.77 / $475.00 / $792.73	Professional		$297.77	$475.00	$792.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.62 / $119.21 / $154.00	Professional	26	$75.62	$119.21	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $241.83 / $335.00 / $453.80	Professional	TC	$241.83	$335.00	$453.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $187.00 / $224.55 / $267.92	Professional		$187.00	$224.55	$267.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.54 / $67.40 / $159.28	Professional	26	$56.54	$67.40	$159.28
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $412.29 / $1,100.00 / $1,267.50	Professional		$412.29	$1,100.00	$1,267.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.01 / $53.01 / $53.01	Facility	26	$53.01	$53.01	$53.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.82 / $577.66 / $1,024.00	Professional		$284.82	$577.66	$1,024.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.21 / $96.94 / $162.96	Professional	26	$55.21	$96.94	$162.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $217.56 / $472.93 / $825.71	Professional	TC	$217.56	$472.93	$825.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $369.01 / $490.19 / $1,416.80	Professional		$369.01	$490.19	$1,416.80
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.30 / $101.05 / $137.63	Professional	26	$86.30	$101.05	$137.63
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.94 / $339.13 / $459.71	Professional	TC	$281.94	$339.13	$459.71
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $305.92 / $359.91 / $635.01	Professional		$305.92	$359.91	$635.01
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.23 / $76.75 / $106.45	Professional	26	$65.23	$76.75	$106.45
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $240.69 / $283.16 / $499.60	Professional	TC	$240.69	$283.16	$499.60
United Facility/Professional Professional Modifier Low / Median / High Price $282.01 / $482.93 / $791.53	Professional		$282.01	$482.93	$791.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.63 / $88.22 / $147.86	Professional	26	$60.63	$88.22	$147.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.96 / $362.60 / $643.32	Professional	TC	$218.96	$362.60	$643.32