Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.20 / $139.31 / $518.49	Facility	26	$119.20	$139.31	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $349.25 / $431.39 / $1,193.00	Professional		$349.25	$431.39	$1,193.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.17 / $133.05 / $259.56	Professional	26	$101.17	$133.05	$259.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $240.85 / $300.63 / $565.00	Professional	TC	$240.85	$300.63	$565.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.58 / $255.52 / $345.39	Professional		$223.58	$255.52	$345.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.67 / $93.22 / $192.93	Professional	26	$77.67	$93.22	$192.93
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $187.07 / $576.14 / $1,921.90	Professional		$187.07	$576.14	$1,921.90
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $109.67 / $191.00 / $331.13	Professional	26	$109.67	$191.00	$331.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.04 / $74.04 / $74.04	Facility	26	$74.04	$74.04	$74.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $336.15 / $795.10 / $1,481.88	Professional		$336.15	$795.10	$1,481.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.59 / $131.47 / $221.87	Professional	26	$73.59	$131.47	$221.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $264.14 / $624.42 / $1,272.59	Professional	TC	$264.14	$624.42	$1,272.59
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $400.72 / $531.95 / $2,224.96	Professional		$400.72	$531.95	$2,224.96
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.61 / $137.09 / $2,459.90	Professional	26	$117.61	$137.09	$2,459.90
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $282.33 / $339.60 / $2,459.90	Professional	TC	$282.33	$339.60	$2,459.90
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $326.08 / $383.64 / $721.11	Professional		$326.08	$383.64	$721.11
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.23 / $102.62 / $153.88	Professional	26	$87.23	$102.62	$153.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $238.88 / $281.02 / $495.87	Professional	TC	$238.88	$281.02	$495.87
United Facility/Professional Professional Modifier Low / Median / High Price $305.39 / $556.29 / $1,003.21	Professional		$305.39	$556.29	$1,003.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.37 / $117.95 / $197.69	Professional	26	$82.37	$117.95	$197.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $211.37 / $356.51 / $761.73	Professional	TC	$211.37	$356.51	$761.73