Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $309.03 / $562.34	Facility	26	$77.62	$309.03	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $331.13 / $691.83	Professional		$169.82	$331.13	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $120.23 / $398.11	Professional	26	$77.62	$120.23	$398.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	50	$173.78	$173.78	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $562.34	Professional	TC	$162.18	$245.47	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $177.83 / $181.97	Professional		$177.83	$177.83	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $83.18 / $204.17	Professional	26	$69.18	$83.18	$204.17
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Professional		$158.49	$158.49	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Facility	26	$63.10	$63.10	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $489.78 / $831.76	Professional		$263.03	$489.78	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $112.20 / $190.55	Professional	26	$64.57	$112.20	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $371.54 / $645.65	Professional	TC	$194.98	$371.54	$645.65
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $512.86	Professional		$316.23	$380.19	$512.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $117.49 / $162.18	Professional	26	$102.33	$117.49	$162.18
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $257.04 / $354.81	Professional	TC	$213.80	$257.04	$354.81
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $275.42 / $616.60	Professional		$234.42	$275.42	$616.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $89.13 / $147.91	Professional	26	$75.86	$89.13	$147.91
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $190.55 / $467.74	Professional	TC	$158.49	$190.55	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $436.52 / $758.58	Professional		$269.15	$436.52	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $100.00 / $177.83	Professional	26	$67.61	$100.00	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $331.13 / $588.84	Professional	TC	$199.53	$331.13	$588.84