Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.11 / $60.44 / $206.49	Facility	26	$44.11	$60.44	$206.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.92 / $182.97 / $413.00	Professional		$64.92	$182.97	$413.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.83 / $50.71 / $109.00	Professional	26	$43.83	$50.71	$109.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $142.78 / $142.78 / $490.74	Professional	50	$142.78	$142.78	$490.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.19 / $141.87 / $231.46	Professional	TC	$82.19	$141.87	$231.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.75 / $90.81 / $108.16	Professional		$85.75	$90.81	$108.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $41.99 / $97.36	Professional	26	$34.61	$41.99	$97.36
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $51.21 / $148.19 / $395.25	Professional		$51.21	$148.19	$395.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $56.01 / $86.04 / $125.13	Professional	26	$56.01	$86.04	$125.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.84 / $35.84 / $35.84	Facility	26	$35.84	$35.84	$35.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.81 / $256.30 / $451.80	Professional		$127.81	$256.30	$451.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.64 / $61.28 / $102.32	Professional	26	$33.64	$61.28	$102.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.18 / $193.62 / $331.10	Professional	TC	$91.18	$193.62	$331.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $153.59 / $203.25 / $621.14	Professional		$153.59	$203.25	$621.14
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.68 / $61.75 / $568.27	Professional	26	$52.68	$61.75	$568.27
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.41 / $120.79 / $568.27	Professional	TC	$100.41	$120.79	$568.27
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.69 / $151.41 / $327.99	Professional		$128.69	$151.41	$327.99
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.93 / $46.98 / $71.65	Professional	26	$39.93	$46.98	$71.65
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.77 / $104.43 / $179.84	Professional	TC	$88.77	$104.43	$179.84
United Facility/Professional Professional Modifier Low / Median / High Price $112.22 / $203.37 / $334.79	Professional		$112.22	$203.37	$334.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.35 / $56.92 / $94.08	Professional	26	$38.35	$56.92	$94.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $132.47 / $249.33	Professional	TC	$77.00	$132.47	$249.33