Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.20 / $146.04 / $518.49	Facility	26	$119.20	$146.04	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $299.77 / $425.00 / $1,032.08	Professional		$299.77	$425.00	$1,032.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.43 / $126.00 / $176.40	Professional	26	$95.43	$126.00	$176.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.95 / $282.87 / $422.10	Professional	TC	$199.95	$282.87	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.18 / $225.57 / $384.66	Professional		$207.18	$225.57	$384.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.40 / $96.15 / $180.60	Professional	26	$80.40	$96.15	$180.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $196.14 / $462.83 / $1,057.28	Professional		$196.14	$462.83	$1,057.28
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $114.96 / $287.30 / $575.79	Professional	26	$114.96	$287.30	$575.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $283.64 / $484.48 / $820.05	Professional		$283.64	$484.48	$820.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.73 / $137.05 / $229.62	Professional	26	$78.73	$137.05	$229.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.31 / $339.77 / $597.14	Professional	TC	$204.31	$339.77	$597.14
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $405.68 / $502.44 / $920.76	Professional		$405.68	$502.44	$920.76
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.38 / $143.69 / $660.81	Professional	26	$123.38	$143.69	$660.81
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.55 / $338.65 / $459.06	Professional	TC	$281.55	$338.65	$459.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.16 / $389.60 / $619.65	Professional		$331.16	$389.60	$619.65
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.69 / $107.87 / $165.87	Professional	26	$91.69	$107.87	$165.87
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.48 / $281.74 / $425.86	Professional	TC	$239.48	$281.74	$425.86
United Facility/Professional Professional Modifier Low / Median / High Price $309.02 / $565.38 / $981.02	Professional		$309.02	$565.38	$981.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.95 / $117.36 / $207.78	Professional	26	$68.95	$117.36	$207.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $216.26 / $389.58 / $840.99	Professional	TC	$216.26	$389.58	$840.99