Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.85 / $119.21 / $518.49	Facility	26	$85.85	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $230.37 / $425.00 / $1,090.22	Professional		$230.37	$425.00	$1,090.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.12 / $119.21 / $176.40	Professional	26	$64.12	$119.21	$176.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $956.25 / $1,476.00 / $1,557.00	Professional	50	$956.25	$1,476.00	$1,557.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $167.32 / $299.00 / $441.00	Professional	TC	$167.32	$299.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $146.52 / $192.82 / $228.18	Professional		$146.52	$192.82	$228.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.26 / $55.96 / $105.09	Professional	26	$47.26	$55.96	$105.09
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $289.23 / $289.23 / $289.23	Professional	50	$289.23	$289.23	$289.23
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $65.89 / $221.00 / $1,100.00	Professional		$65.89	$221.00	$1,100.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $75.17 / $103.33 / $800.00	Professional	26	$75.17	$103.33	$800.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.19 / $44.19 / $44.19	Facility	26	$44.19	$44.19	$44.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $238.05 / $522.52 / $865.57	Professional		$238.05	$522.52	$865.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $80.34 / $136.03	Professional	26	$45.36	$80.34	$136.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.87 / $430.97 / $745.69	Professional	TC	$186.87	$430.97	$745.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $264.00 / $350.32 / $1,285.07	Professional		$264.00	$350.32	$1,285.07
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.61 / $83.80 / $1,157.93	Professional	26	$71.61	$83.80	$1,157.93
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.76 / $230.66 / $1,157.93	Professional	TC	$191.76	$230.66	$1,157.93
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $214.97 / $252.90 / $524.63	Professional		$214.97	$252.90	$524.63
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.73 / $63.21 / $111.53	Professional	26	$53.73	$63.21	$111.53
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $161.24 / $189.69 / $429.81	Professional	TC	$161.24	$189.69	$429.81
United Facility/Professional Professional Modifier Low / Median / High Price $201.47 / $366.31 / $637.39	Professional		$201.47	$366.31	$637.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.39 / $72.67 / $126.12	Professional	26	$53.39	$72.67	$126.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.78 / $261.64 / $495.82	Professional	TC	$147.78	$261.64	$495.82