Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.35 / $99.36 / $481.29	Facility	26	$99.35	$99.36	$481.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.77 / $409.75 / $530.10	Professional		$269.77	$409.75	$530.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.35 / $116.34 / $207.27	Professional	26	$99.35	$116.34	$207.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.22 / $295.20 / $398.71	Professional	TC	$159.22	$295.20	$398.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $202.73 / $248.28 / $421.73	Professional		$202.73	$248.28	$421.73
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.52 / $92.22 / $207.32	Professional	26	$83.52	$92.22	$207.32
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $105.20 / $199.01 / $199.01	Professional		$105.20	$199.01	$199.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.84 / $78.84 / $78.84	Facility	26	$78.84	$78.84	$78.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $321.01 / $626.41 / $1,073.34	Professional		$321.01	$626.41	$1,073.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.15 / $139.78 / $237.17	Professional	26	$79.15	$139.78	$237.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $227.91 / $455.46 / $852.41	Professional	TC	$227.91	$455.46	$852.41
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $343.63 / $455.08 / $1,527.48	Professional		$343.63	$455.08	$1,527.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $126.20 / $147.06 / $201.55	Professional	26	$126.20	$147.06	$201.55
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $216.56 / $260.51 / $353.02	Professional	TC	$216.56	$260.51	$353.02
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $246.61 / $290.13 / $511.89	Professional		$246.61	$290.13	$511.89
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.14 / $110.75 / $158.40	Professional	26	$94.14	$110.75	$158.40
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $179.38 / $316.49	Professional	TC	$152.47	$179.38	$316.49
United Facility/Professional Professional Modifier Low / Median / High Price $374.70 / $561.41 / $879.26	Professional		$374.70	$561.41	$879.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.75 / $132.99 / $211.83	Professional	26	$93.75	$132.99	$211.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $274.20 / $408.11 / $690.52	Professional	TC	$274.20	$408.11	$690.52