Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.20 / $119.21 / $518.49	Facility	26	$119.20	$119.21	$518.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $342.51 / $425.00 / $677.00	Professional		$342.51	$425.00	$677.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.92 / $126.00 / $154.00	Professional	26	$82.92	$126.00	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $255.30 / $303.27 / $478.00	Professional	TC	$255.30	$303.27	$478.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $102.12 / $102.12 / $102.12	Professional	26	$102.12	$102.12	$102.12
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $91.80 / $91.80 / $91.80	Professional		$91.80	$91.80	$91.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.48 / $59.48 / $59.48	Facility	26	$59.48	$59.48	$59.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $297.25 / $568.50 / $966.36	Professional		$297.25	$568.50	$966.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.42 / $107.03 / $181.17	Professional	26	$60.42	$107.03	$181.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $225.67 / $462.19 / $808.50	Professional	TC	$225.67	$462.19	$808.50
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $395.47 / $525.42 / $1,385.84	Professional		$395.47	$525.42	$1,385.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.92 / $111.06 / $1,214.20	Professional	26	$94.92	$111.06	$1,214.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $299.70 / $360.39 / $1,214.20	Professional	TC	$299.70	$360.39	$1,214.20
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $321.07 / $377.73 / $602.64	Professional		$321.07	$377.73	$602.64
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $71.37 / $83.96 / $148.13	Professional	26	$71.37	$83.96	$148.13
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $249.70 / $293.76 / $518.30	Professional	TC	$249.70	$293.76	$518.30
United Facility/Professional Professional Modifier Low / Median / High Price $268.20 / $468.16 / $799.50	Professional		$268.20	$468.16	$799.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.20 / $95.34 / $160.50	Professional	26	$62.20	$95.34	$160.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.82 / $372.15 / $647.39	Professional	TC	$201.82	$372.15	$647.39