Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.56 / $62.56 / $196.63	Facility	26	$62.56	$62.56	$196.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $320.26 / $440.68 / $695.07	Professional		$320.26	$440.68	$695.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.46 / $72.67 / $101.87	Professional	26	$58.46	$72.67	$101.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $264.63 / $366.83 / $521.10	Professional	TC	$264.63	$366.83	$521.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $378.38 / $756.77 / $756.77	Professional		$378.38	$756.77	$756.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.68 / $90.33 / $129.07	Professional	26	$59.68	$90.33	$129.07
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $134.99 / $798.78 / $1,310.39	Professional		$134.99	$798.78	$1,310.39
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $78.65 / $131.62 / $182.62	Professional	26	$78.65	$131.62	$182.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $352.26 / $589.60 / $1,021.90	Professional		$352.26	$589.60	$1,021.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.33 / $92.45 / $153.57	Professional	26	$53.33	$92.45	$153.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $278.27 / $475.69 / $774.24	Professional	TC	$278.27	$475.69	$774.24
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $591.23 / $591.23 / $591.23	Professional		$591.23	$591.23	$591.23
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $98.31 / $98.31 / $98.31	Professional	26	$98.31	$98.31	$98.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $492.91 / $492.91 / $492.91	Professional	TC	$492.91	$492.91	$492.91
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $400.64 / $471.34 / $718.34	Professional		$400.64	$471.34	$718.34
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.97 / $74.08 / $111.08	Professional	26	$62.97	$74.08	$111.08
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $337.67 / $397.26 / $595.77	Professional	TC	$337.67	$397.26	$595.77
United Facility/Professional Professional Modifier Low / Median / High Price $411.98 / $602.50 / $1,015.64	Professional		$411.98	$602.50	$1,015.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.59 / $95.36 / $156.41	Professional	26	$69.59	$95.36	$156.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $344.97 / $503.55 / $844.11	Professional	TC	$344.97	$503.55	$844.11