Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $217.72 / $217.73 / $606.03	Facility	26	$217.72	$217.73	$606.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $407.34 / $487.17 / $698.50	Professional		$407.34	$487.17	$698.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $188.34 / $217.38 / $344.83	Professional	26	$188.34	$217.38	$344.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.32 / $269.44 / $392.36	Professional	TC	$214.32	$269.44	$392.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $347.07 / $347.07 / $347.07	Professional		$347.07	$347.07	$347.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $180.26 / $236.05 / $387.86	Professional	26	$180.26	$236.05	$387.86
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $237.90 / $1,017.00 / $1,674.75	Professional		$237.90	$1,017.00	$1,674.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $387.93 / $623.76 / $1,150.74	Professional		$387.93	$623.76	$1,150.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $183.26 / $277.39 / $485.73	Professional	26	$183.26	$277.39	$485.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.90 / $340.56 / $666.05	Professional	TC	$200.90	$340.56	$666.05
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $553.85 / $656.08 / $656.08	Professional		$553.85	$656.08	$656.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $259.82 / $303.01 / $303.01	Professional	26	$259.82	$303.01	$303.01
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $294.04 / $353.06 / $353.06	Professional	TC	$294.04	$353.06	$353.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $376.52 / $474.72 / $656.23	Professional		$376.52	$474.72	$656.23
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $182.15 / $219.95 / $379.23	Professional	26	$182.15	$219.95	$379.23
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $232.59 / $273.64 / $432.56	Professional	TC	$232.59	$273.64	$432.56
United Facility/Professional Professional Modifier Low / Median / High Price $367.80 / $578.39 / $982.46	Professional		$367.80	$578.39	$982.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $164.18 / $255.66 / $428.00	Professional	26	$164.18	$255.66	$428.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $197.72 / $316.99 / $532.47	Professional	TC	$197.72	$316.99	$532.47