Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $89.13 / $416.87	Facility	26	$56.23	$89.13	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $363.08 / $1,230.27	Professional		$229.09	$363.08	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $87.10 / $208.93	Professional	26	$57.54	$87.10	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $630.96	Professional	TC	$162.18	$245.47	$630.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $208.93 / $288.40	Professional		$162.18	$208.93	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $123.03	Professional	26	$48.98	$61.66	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $162.18 / $251.19	Professional	TC	$138.04	$162.18	$251.19
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $288.40 / $602.56	Professional		$104.71	$288.40	$602.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $407.38 / $724.44	Professional		$218.78	$407.38	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $83.18 / $141.25	Professional	26	$47.86	$83.18	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $316.23 / $575.44	Professional	TC	$165.96	$316.23	$575.44
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $346.74 / $912.01	Professional		$288.40	$346.74	$912.01
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $87.10 / $912.01	Professional	26	$75.86	$87.10	$912.01
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $257.04 / $912.01	Professional	TC	$213.80	$257.04	$912.01
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $537.03	Professional		$208.93	$257.04	$537.03
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $120.23	Professional	26	$57.54	$67.61	$120.23
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $190.55 / $371.54	Professional	TC	$158.49	$190.55	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $346.74 / $588.84	Professional		$218.78	$346.74	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $75.86 / $131.83	Professional	26	$52.48	$75.86	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $269.15 / $467.74	Professional	TC	$165.96	$269.15	$467.74