Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.71 / $53.71 / $258.70	Facility	26	$53.71	$53.71	$258.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.63 / $215.42 / $308.04	Professional		$136.63	$215.42	$308.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.71 / $72.50 / $113.96	Professional	26	$53.71	$72.50	$113.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.66 / $152.55 / $243.50	Professional	TC	$58.66	$152.55	$243.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $97.55 / $129.26	Professional	26	$72.33	$97.55	$129.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.33 / $43.33 / $43.33	Facility	26	$43.33	$43.33	$43.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.22 / $289.80 / $623.34	Professional		$127.22	$289.80	$623.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.96 / $88.49 / $151.94	Professional	26	$59.96	$88.49	$151.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.79 / $186.84 / $539.83	Professional	TC	$56.79	$186.84	$539.83
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $188.77 / $220.88 / $568.54	Professional		$188.77	$220.88	$568.54
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.45 / $119.58 / $168.61	Professional	26	$104.45	$119.58	$168.61
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.33 / $101.30 / $137.82	Professional	TC	$84.33	$101.30	$137.82
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.66 / $168.07 / $294.17	Professional		$112.66	$168.07	$294.17
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.58 / $88.92 / $141.43	Professional	26	$75.58	$88.92	$141.43
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.27 / $79.14 / $214.67	Professional	TC	$67.27	$79.14	$214.67
United Facility/Professional Professional Modifier Low / Median / High Price $123.69 / $225.63 / $483.55	Professional		$123.69	$225.63	$483.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.78 / $97.56 / $158.94	Professional	26	$58.78	$97.56	$158.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.44 / $100.69 / $272.91	Professional	TC	$55.44	$100.69	$272.91