Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.00 / $65.79 / $238.01	Facility	26	$47.00	$65.79	$238.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.77 / $259.41 / $458.00	Professional		$177.77	$259.41	$458.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.00 / $56.43 / $103.44	Professional	26	$47.00	$56.43	$103.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.27 / $193.59 / $328.44	Professional	TC	$137.27	$193.59	$328.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.96 / $48.00 / $101.15	Professional	26	$36.96	$48.00	$101.15
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $50.45 / $167.05 / $167.05	Professional		$50.45	$167.05	$167.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.97 / $37.97 / $37.97	Facility	26	$37.97	$37.97	$37.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $167.79 / $312.36 / $551.39	Professional		$167.79	$312.36	$551.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.95 / $68.84 / $115.98	Professional	26	$38.95	$68.84	$115.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.90 / $244.00 / $428.41	Professional	TC	$125.90	$244.00	$428.41
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $237.19 / $314.86 / $741.04	Professional		$237.19	$314.86	$741.04
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.40 / $71.89 / $662.80	Professional	26	$61.40	$71.89	$662.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $175.24 / $210.76 / $662.80	Professional	TC	$175.24	$210.76	$662.80
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.67 / $218.44 / $385.54	Professional		$185.67	$218.44	$385.54
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.15 / $54.29 / $80.95	Professional	26	$46.15	$54.29	$80.95
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $139.53 / $164.15 / $289.62	Professional	TC	$139.53	$164.15	$289.62
United Facility/Professional Professional Modifier Low / Median / High Price $191.80 / $270.77 / $442.95	Professional		$191.80	$270.77	$442.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $64.11 / $103.68	Professional	26	$43.47	$64.11	$103.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.89 / $201.52 / $333.86	Professional	TC	$123.89	$201.52	$333.86