Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $63.10 / $302.00	Facility	26	$43.65	$63.10	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $177.83 / $588.84	Professional		$61.66	$177.83	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $74.13 / $194.98	Professional	26	$45.71	$74.13	$194.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $177.83 / $199.53 / $199.53	Professional	50	$177.83	$199.53	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $165.96 / $416.87	Professional	TC	$102.33	$165.96	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $190.55	Professional		$104.71	$138.04	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $87.10	Professional	26	$35.48	$44.67	$87.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $134.90 / $147.91	Professional	TC	$97.72	$134.90	$147.91
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $120.23 / $524.81	Professional		$51.29	$120.23	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $35.48 / $35.48	Facility	26	$35.48	$35.48	$35.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $257.04 / $446.68	Professional		$134.90	$257.04	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $63.10 / $107.15	Professional	26	$34.67	$63.10	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $190.55 / $331.13	Professional	TC	$100.00	$190.55	$331.13
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $218.78 / $562.34	Professional		$181.97	$218.78	$562.34
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $562.34	Professional	26	$54.95	$63.10	$562.34
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $154.88 / $562.34	Professional	TC	$128.82	$154.88	$562.34
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $165.96 / $323.59	Professional		$138.04	$165.96	$323.59
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $47.86 / $81.28	Professional	26	$40.74	$47.86	$81.28
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $114.82 / $245.47	Professional	TC	$97.72	$114.82	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $380.19	Professional		$134.90	$218.78	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $95.50	Professional	26	$37.15	$54.95	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $162.18 / $288.40	Professional	TC	$97.72	$162.18	$288.40