Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.70 / $119.21 / $518.49	Facility	26	$113.70	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.69 / $425.00 / $661.50	Professional		$277.69	$425.00	$661.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.50 / $126.00 / $176.40	Professional	26	$82.50	$126.00	$176.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.18 / $212.50 / $284.36	Professional	52	$138.18	$212.50	$284.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $191.40 / $299.00 / $462.42	Professional	TC	$191.40	$299.00	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $163.76 / $203.79 / $276.93	Professional		$163.76	$203.79	$276.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.91 / $67.20 / $173.49	Professional	26	$64.91	$67.20	$173.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $132.58 / $132.58	Professional	TC	$132.58	$132.58	$132.58
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $533.07 / $533.07 / $533.07	Professional		$533.07	$533.07	$533.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.54 / $58.54 / $58.54	Facility	26	$58.54	$58.54	$58.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.35 / $554.49 / $964.23	Professional		$240.35	$554.49	$964.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.16 / $106.66 / $178.62	Professional	26	$60.16	$106.66	$178.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $168.86 / $406.88 / $827.15	Professional	TC	$168.86	$406.88	$827.15
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $321.10 / $425.97 / $1,504.78	Professional		$321.10	$425.97	$1,504.78
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.63 / $110.71 / $1,414.50	Professional	26	$94.63	$110.71	$1,414.50
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $225.67 / $271.36 / $1,414.50	Professional	TC	$225.67	$271.36	$1,414.50
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.14 / $302.52 / $584.15	Professional		$257.14	$302.52	$584.15
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $71.15 / $83.70 / $133.13	Professional	26	$71.15	$83.70	$133.13
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.01 / $218.83 / $349.00	Professional	TC	$186.01	$218.83	$349.00
United Facility/Professional Professional Modifier Low / Median / High Price $253.79 / $453.66 / $737.01	Professional		$253.79	$453.66	$737.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.42 / $92.50 / $166.99	Professional	26	$67.42	$92.50	$166.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $174.83 / $277.58 / $555.03	Professional	TC	$174.83	$277.58	$555.03