Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.03 / $29.04 / $125.00	Facility	26	$29.03	$29.04	$125.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.49 / $104.51 / $180.03	Professional		$83.49	$104.51	$180.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.56 / $33.86 / $54.89	Professional	26	$27.56	$33.86	$54.89
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $54.16 / $232.10 / $661.50	Professional	50	$54.16	$232.10	$661.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.93 / $68.13 / $113.65	Professional	TC	$55.93	$68.13	$113.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.41 / $71.12 / $87.21	Professional		$47.41	$71.12	$87.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.07 / $41.88 / $68.81	Professional	26	$33.07	$41.88	$68.81
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $91.50 / $126.18 / $153.60	Professional	50	$91.50	$126.18	$153.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $60.75 / $146.07 / $269.31	Professional		$60.75	$146.07	$269.31
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $40.36 / $54.60 / $92.49	Professional	26	$40.36	$54.60	$92.49
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $49.65 / $175.23 / $283.50	Professional	50	$49.65	$175.23	$283.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.56 / $143.51 / $237.25	Professional		$77.56	$143.51	$237.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.45 / $46.64 / $77.87	Professional	26	$25.45	$46.64	$77.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.87 / $97.60 / $160.63	Professional	TC	$52.87	$97.60	$160.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $141.54 / $242.82	Professional		$116.74	$141.54	$242.82
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.10 / $45.88 / $79.25	Professional	26	$38.10	$45.88	$79.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.64 / $95.66 / $163.57	Professional	TC	$78.64	$95.66	$163.57
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.42 / $90.32 / $157.13	Professional		$70.42	$90.32	$157.13
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.09 / $29.39 / $104.19	Professional	26	$24.09	$29.39	$104.19
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.23 / $60.92 / $112.40	Professional	TC	$51.23	$60.92	$112.40
United Facility/Professional Professional Modifier Low / Median / High Price $79.81 / $119.89 / $207.08	Professional		$79.81	$119.89	$207.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.51 / $39.19 / $66.26	Professional	26	$25.51	$39.19	$66.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.19 / $80.41 / $140.88	Professional	TC	$53.19	$80.41	$140.88