Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $383.81 / $383.81 / $1,130.98	Facility	26	$383.81	$383.81	$1,130.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,571.74 / $2,114.63 / $3,059.56	Professional		$1,571.74	$2,114.63	$3,059.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.37 / $387.09 / $642.00	Professional	26	$347.37	$387.09	$642.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.39 / $1,745.82 / $2,474.75	Professional	TC	$1,249.39	$1,745.82	$2,474.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,330.86 / $1,330.86 / $1,435.43	Professional		$1,330.86	$1,330.86	$1,435.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $336.53 / $618.83 / $723.82	Professional	26	$336.53	$618.83	$723.82
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $445.03 / $1,903.50 / $4,503.47	Professional		$445.03	$1,903.50	$4,503.47
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $365.03 / $694.73 / $1,003.40	Professional	26	$365.03	$694.73	$1,003.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,549.68 / $2,519.00 / $4,503.47	Professional		$1,549.68	$2,519.00	$4,503.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $352.36 / $513.41 / $895.65	Professional	26	$352.36	$513.41	$895.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,198.43 / $1,977.92 / $3,609.16	Professional	TC	$1,198.43	$1,977.92	$3,609.16
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $2,174.23 / $2,594.94 / $2,594.94	Professional		$2,174.23	$2,594.94	$2,594.94
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $485.09 / $565.49 / $565.49	Professional	26	$485.09	$565.49	$565.49
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,689.14 / $2,029.48 / $2,029.48	Professional	TC	$1,689.14	$2,029.48	$2,029.48
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,680.78 / $1,977.39 / $2,910.99	Professional		$1,680.78	$1,977.39	$2,910.99
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $339.12 / $409.49 / $2,073.58	Professional	26	$339.12	$409.49	$2,073.58
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,268.09 / $1,567.90 / $2,587.65	Professional	TC	$1,268.09	$1,567.90	$2,587.65
United Facility/Professional Professional Modifier Low / Median / High Price $1,379.71 / $2,225.19 / $3,898.38	Professional		$1,379.71	$2,225.19	$3,898.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $308.82 / $475.12 / $796.81	Professional	26	$308.82	$475.12	$796.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,079.69 / $1,615.12 / $3,050.91	Professional	TC	$1,079.69	$1,615.12	$3,050.91