Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $165.96 / $512.86	Facility	26	$85.11	$165.96	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $426.58 / $1,621.81	Professional		$147.91	$426.58	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $128.82 / $371.54	Professional	26	$64.57	$128.82	$371.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $131.83 / $724.44 / $1,548.82	Professional	50	$131.83	$724.44	$1,548.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $323.59 / $758.58	Professional	TC	$181.97	$323.59	$758.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $177.83 / $363.08	Professional		$154.88	$177.83	$363.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $120.23	Professional	26	$47.86	$58.88	$120.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $190.55 / $269.15	Professional	TC	$190.55	$190.55	$269.15
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $269.15 / $977.24	Professional		$95.50	$269.15	$977.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $44.67	Facility	26	$44.67	$44.67	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $467.74 / $758.58	Professional		$229.09	$467.74	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $83.18 / $141.25	Professional	26	$46.77	$83.18	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $363.08 / $660.69	Professional	TC	$165.96	$363.08	$660.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $1,148.15	Professional		$263.03	$316.23	$1,148.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $85.11 / $1,148.15	Professional	26	$72.44	$85.11	$1,148.15
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $234.42 / $1,148.15	Professional	TC	$194.98	$234.42	$1,148.15
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $263.03 / $588.84	Professional		$223.87	$263.03	$588.84
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $64.57 / $114.82	Professional	26	$54.95	$64.57	$114.82
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $489.78	Professional	TC	$169.82	$199.53	$489.78
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $346.74 / $660.69	Professional		$194.98	$346.74	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $69.18 / $131.83	Professional	26	$47.86	$69.18	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $257.04 / $537.03	Professional	TC	$144.54	$257.04	$537.03