Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.60 / $64.48 / $249.45	Facility	26	$49.60	$64.48	$249.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.38 / $275.00 / $483.62	Professional		$164.38	$275.00	$483.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.29 / $60.62 / $122.00	Professional	26	$50.29	$60.62	$122.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.21 / $206.63 / $310.80	Professional	TC	$111.21	$206.63	$310.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.77 / $53.78 / $106.12	Professional	26	$38.77	$53.78	$106.12
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $82.65 / $103.58 / $138.60	Professional		$82.65	$103.58	$138.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.86 / $39.86 / $39.86	Facility	26	$39.86	$39.86	$39.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.50 / $337.72 / $568.42	Professional		$161.50	$337.72	$568.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.12 / $72.18 / $121.68	Professional	26	$41.12	$72.18	$121.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.16 / $260.87 / $429.55	Professional	TC	$115.16	$260.87	$429.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $200.46 / $265.63 / $804.71	Professional		$200.46	$265.63	$804.71
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.37 / $75.43 / $102.63	Professional	26	$64.37	$75.43	$102.63
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.49 / $162.90 / $221.08	Professional	TC	$135.49	$162.90	$221.08
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $146.63 / $191.53 / $338.27	Professional		$146.63	$191.53	$338.27
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.65 / $57.24 / $79.98	Professional	26	$48.65	$57.24	$79.98
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.15 / $134.29 / $243.38	Professional	TC	$114.15	$134.29	$243.38
United Facility/Professional Professional Modifier Low / Median / High Price $151.93 / $264.85 / $436.08	Professional		$151.93	$264.85	$436.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $68.48 / $114.36	Professional	26	$46.70	$68.48	$114.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.27 / $187.30 / $322.18	Professional	TC	$105.27	$187.30	$322.18