Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $112.20 / $524.81	Facility	26	$70.79	$112.20	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $389.05 / $1,513.56	Professional		$251.19	$389.05	$1,513.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $93.33 / $257.04	Professional	26	$74.13	$93.33	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $602.56	Professional	TC	$162.18	$257.04	$602.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $223.87 / $269.15	Professional		$87.10	$223.87	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $77.62 / $151.36	Professional	26	$61.66	$77.62	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $165.96 / $229.09	Professional	TC	$162.18	$165.96	$229.09
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $141.25 / $288.40	Professional		$77.62	$141.25	$288.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $57.54	Facility	26	$57.54	$57.54	$57.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $478.63 / $891.25	Professional		$229.09	$478.63	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $173.78	Professional	26	$60.26	$104.71	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $371.54 / $741.31	Professional	TC	$165.96	$371.54	$741.31
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $371.54 / $501.19	Professional		$309.03	$371.54	$501.19
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $109.65 / $147.91	Professional	26	$93.33	$109.65	$147.91
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 $223.87 / $275.42 / $616.60	Professional		$223.87	$275.42	$616.60
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $83.18 / $144.54	Professional	26	$70.79	$83.18	$144.54
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $190.55 / $489.78	Professional	TC	$158.49	$190.55	$489.78
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $398.11 / $707.95	Professional		$229.09	$398.11	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $162.18	Professional	26	$64.57	$93.33	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $275.42 / $602.56	Professional	TC	$165.96	$275.42	$602.56