Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.98 / $21.98 / $118.02	Facility	26	$21.98	$21.98	$118.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.33 / $108.53 / $150.85	Professional		$81.33	$108.53	$150.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.95 / $25.85 / $36.79	Professional	26	$21.95	$25.85	$36.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.35 / $82.54 / $118.83	Professional	TC	$59.35	$82.54	$118.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.52 / $88.52 / $88.52	Professional		$88.52	$88.52	$88.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.96 / $17.96 / $17.96	Facility	26	$17.96	$17.96	$17.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.56 / $135.32 / $212.15	Professional		$89.56	$135.32	$212.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $34.61 / $57.04	Professional	26	$20.66	$34.61	$57.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.22 / $99.56 / $154.26	Professional	TC	$66.22	$99.56	$154.26
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $122.21 / $162.84 / $237.53	Professional		$122.21	$162.84	$237.53
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.68 / $36.75 / $50.79	Professional	26	$31.68	$36.75	$50.79
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.58 / $137.84 / $186.75	Professional	TC	$114.58	$137.84	$186.75
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.07 / $121.26 / $172.68	Professional		$103.07	$121.26	$172.68
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.66 / $28.54 / $119.37	Professional	26	$23.66	$28.54	$119.37
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.41 / $95.93 / $144.46	Professional	TC	$79.41	$95.93	$144.46
United Facility/Professional Professional Modifier Low / Median / High Price $87.93 / $125.75 / $221.75	Professional		$87.93	$125.75	$221.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.58 / $31.38 / $54.56	Professional	26	$20.58	$31.38	$54.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.73 / $99.84 / $171.81	Professional	TC	$65.73	$99.84	$171.81