Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.25 / $30.25 / $42.34	Facility	26	$30.25	$30.25	$42.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.60 / $116.36 / $266.89	Professional		$98.60	$116.36	$266.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $28.03 / $65.81	Professional	26	$22.85	$28.03	$65.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.65 / $88.84 / $141.31	Professional	TC	$72.65	$88.84	$141.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.86 / $173.86 / $173.86	Professional		$173.86	$173.86	$173.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.62 / $22.62 / $22.62	Professional	26	$22.62	$22.62	$22.62
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $19.10 / $42.60 / $233.25	Professional		$19.10	$42.60	$233.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $56.43 / $70.90	Professional	26	$28.98	$56.43	$70.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.08 / $148.90 / $317.33	Professional		$103.08	$148.90	$317.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.03 / $35.58 / $70.70	Professional	26	$24.03	$35.58	$70.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.45 / $115.31 / $244.80	Professional	TC	$78.45	$115.31	$244.80
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $111.95 / $148.86 / $306.74	Professional		$111.95	$148.86	$306.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.48 / $35.25 / $72.56	Professional	26	$26.48	$35.25	$72.56
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.47 / $113.61 / $234.19	Professional	TC	$85.47	$113.61	$234.19
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.84 / $98.10 / $169.56	Professional		$79.84	$98.10	$169.56
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $23.86 / $111.40	Professional	26	$19.80	$23.86	$111.40
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.04 / $74.23 / $153.72	Professional	TC	$60.04	$74.23	$153.72
United Facility/Professional Professional Modifier Low / Median / High Price $90.62 / $118.68 / $236.55	Professional		$90.62	$118.68	$236.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.90 / $29.23 / $55.41	Professional	26	$21.90	$29.23	$55.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.63 / $92.69 / $189.97	Professional	TC	$67.63	$92.69	$189.97