Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.58 / $141.58 / $604.45	Facility	26	$141.58	$141.58	$604.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $243.18 / $279.74 / $378.73	Professional		$243.18	$279.74	$378.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $126.17 / $141.58 / $205.82	Professional	26	$126.17	$141.58	$205.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.56 / $133.93 / $181.69	Professional	TC	$117.56	$133.93	$181.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $122.36 / $122.36 / $122.36	Professional	26	$122.36	$122.36	$122.36
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $161.66 / $161.66 / $220.60	Professional		$161.66	$161.66	$220.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $238.74 / $362.70 / $653.71	Professional		$238.74	$362.70	$653.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $124.07 / $187.78 / $330.54	Professional	26	$124.07	$187.78	$330.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.18 / $178.80 / $323.00	Professional	TC	$113.18	$178.80	$323.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $339.53 / $401.49 / $401.49	Professional		$339.53	$401.49	$401.49
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $176.37 / $205.54 / $205.54	Professional	26	$176.37	$205.54	$205.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $163.15 / $195.96 / $195.96	Professional	TC	$163.15	$195.96	$195.96
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.58 / $227.89 / $365.80	Professional		$169.58	$227.89	$365.80
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.95 / $128.33 / $252.78	Professional	26	$99.95	$128.33	$252.78
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.80 / $123.36 / $236.23	Professional	TC	$99.80	$123.36	$236.23
United Facility/Professional Professional Modifier Low / Median / High Price $224.83 / $341.02 / $568.14	Professional		$224.83	$341.02	$568.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $111.38 / $166.73 / $289.67	Professional	26	$111.38	$166.73	$289.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.64 / $146.57 / $278.47	Professional	TC	$103.64	$146.57	$278.47