Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.26 / $21.26 / $30.82	Facility	26	$21.26	$21.26	$30.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.59 / $64.03 / $126.00	Professional		$47.59	$64.03	$126.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $19.98 / $49.99	Professional	26	$16.27	$19.98	$49.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.10 / $42.63 / $66.14	Professional	TC	$32.10	$42.63	$66.14
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $60.59 / $82.67 / $135.54	Professional		$60.59	$82.67	$135.54
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $51.49 / $89.17	Professional	26	$20.66	$51.49	$89.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.30 / $86.26 / $164.64	Professional		$53.30	$86.26	$164.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $25.51 / $49.70	Professional	26	$16.98	$25.51	$49.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $60.63 / $116.97	Professional	TC	$36.34	$60.63	$116.97
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $58.43 / $84.71 / $156.22	Professional		$58.43	$84.71	$156.22
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.75 / $25.13 / $485.65	Professional	26	$18.75	$25.13	$485.65
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.27 / $50.84 / $485.65	Professional	TC	$38.27	$50.84	$485.65
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.95 / $51.79 / $91.21	Professional		$42.95	$51.79	$91.21
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $17.02 / $62.86	Professional	26	$14.13	$17.02	$62.86
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.83 / $35.64 / $86.31	Professional	TC	$28.83	$35.64	$86.31
United Facility/Professional Professional Modifier Low / Median / High Price $47.73 / $72.95 / $127.64	Professional		$47.73	$72.95	$127.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.46 / $20.97 / $41.13	Professional	26	$15.46	$20.97	$41.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.32 / $45.29 / $89.08	Professional	TC	$32.32	$45.29	$89.08