Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.21 / $129.10 / $1,076.00	Facility	26	$92.21	$129.10	$1,076.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.10 / $347.21 / $564.00	Professional		$267.10	$347.21	$564.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.22 / $115.80 / $183.15	Professional	26	$92.22	$115.80	$183.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.21 / $237.98 / $344.57	Professional	TC	$159.21	$237.98	$344.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $213.50 / $245.26 / $329.07	Professional		$213.50	$245.26	$329.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.23 / $105.91 / $209.12	Professional	26	$84.23	$105.91	$209.12
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $121.68 / $200.48 / $544.59	Professional		$121.68	$200.48	$544.59
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $133.09 / $183.22 / $295.26	Professional	26	$133.09	$183.22	$295.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $271.64 / $579.40 / $980.24	Professional		$271.64	$579.40	$980.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.70 / $139.41 / $234.24	Professional	26	$79.70	$139.41	$234.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.18 / $452.97 / $727.80	Professional	TC	$182.18	$452.97	$727.80
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $383.03 / $507.95 / $1,238.35	Professional		$383.03	$507.95	$1,238.35
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.22 / $148.54 / $203.10	Professional	26	$127.22	$148.54	$203.10
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $254.85 / $306.38 / $415.90	Professional	TC	$254.85	$306.38	$415.90
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $221.04 / $290.24 / $489.29	Professional		$221.04	$290.24	$489.29
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.23 / $113.56 / $290.92	Professional	26	$94.23	$113.56	$290.92
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $179.38 / $342.51	Professional	TC	$152.47	$179.38	$342.51
United Facility/Professional Professional Modifier Low / Median / High Price $267.87 / $468.04 / $813.58	Professional		$267.87	$468.04	$813.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.11 / $132.99 / $220.69	Professional	26	$90.11	$132.99	$220.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.31 / $307.22 / $577.29	Professional	TC	$195.31	$307.22	$577.29