Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $190.55 / $346.74	Facility	26	$66.07	$190.55	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $537.03	Professional		$112.20	$251.19	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $194.98	Professional	26	$51.29	$81.28	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $208.93 / $416.87	Professional	TC	$138.04	$208.93	$416.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $194.98	Professional		$107.15	$173.78	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $91.20	Professional	26	$40.74	$51.29	$91.20
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $165.96	Professional		$50.12	$50.12	$165.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Facility	26	$38.02	$38.02	$38.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $309.03 / $512.86	Professional		$169.82	$309.03	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $70.79 / $120.23	Professional	26	$39.81	$70.79	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $234.42 / $407.38	Professional	TC	$125.89	$234.42	$407.38
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $281.84 / $660.69	Professional		$239.88	$281.84	$660.69
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $660.69	Professional	26	$63.10	$72.44	$660.69
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $213.80 / $660.69	Professional	TC	$177.83	$213.80	$660.69
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $436.52	Professional		$194.98	$229.09	$436.52
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $56.23 / $95.50	Professional	26	$46.77	$56.23	$95.50
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $173.78 / $331.13	Professional	TC	$147.91	$173.78	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $269.15 / $467.74	Professional		$169.82	$269.15	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $109.65	Professional	26	$42.66	$63.10	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $204.17 / $363.08	Professional	TC	$123.03	$204.17	$363.08