Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.89 / $21.90 / $113.41	Facility	26	$21.89	$21.90	$113.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.90 / $97.30 / $191.93	Professional		$75.90	$97.30	$191.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.97 / $25.69 / $47.13	Professional	26	$20.97	$25.69	$47.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.93 / $69.73 / $102.96	Professional	TC	$54.93	$69.73	$102.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.49 / $88.86 / $120.23	Professional		$60.49	$88.86	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.11 / $21.26 / $24.50	Professional	26	$19.11	$21.26	$24.50
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $28.01 / $28.01 / $28.01	Professional		$28.01	$28.01	$28.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.89 / $137.55 / $238.64	Professional		$82.89	$137.55	$238.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.07 / $35.09 / $57.95	Professional	26	$19.07	$35.09	$57.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.88 / $101.45 / $172.17	Professional	TC	$61.88	$101.45	$172.17
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $117.22 / $149.01 / $255.28	Professional		$117.22	$149.01	$255.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $33.90 / $58.61	Professional	26	$28.18	$33.90	$58.61
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.55 / $115.10 / $196.66	Professional	TC	$94.55	$115.10	$196.66
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.06 / $122.41 / $159.54	Professional		$99.06	$122.41	$159.54
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.94 / $28.84 / $114.73	Professional	26	$23.94	$28.84	$114.73
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.11 / $98.29 / $157.96	Professional	TC	$80.11	$98.29	$157.96
United Facility/Professional Professional Modifier Low / Median / High Price $76.02 / $115.85 / $199.95	Professional		$76.02	$115.85	$199.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.86 / $29.64 / $50.10	Professional	26	$18.86	$29.64	$50.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.66 / $89.29 / $154.86	Professional	TC	$60.66	$89.29	$154.86