Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.43 / $40.43 / $175.22	Facility	26	$40.43	$40.43	$175.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.26 / $66.58 / $140.47	Professional		$52.26	$66.58	$140.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.77 / $39.54 / $53.88	Professional	26	$34.77	$39.54	$53.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.70 / $20.83 / $101.75	Professional	TC	$12.70	$20.83	$101.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.92 / $56.41 / $66.48	Professional	26	$34.92	$56.41	$66.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.44 / $122.43 / $225.01	Professional		$60.44	$122.43	$225.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.43 / $50.36 / $88.69	Professional	26	$33.43	$50.36	$88.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.35 / $76.27 / $145.75	Professional	TC	$12.35	$76.27	$145.75
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $160.37 / $191.26 / $191.26	Professional		$160.37	$191.26	$191.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.79 / $53.43 / $53.43	Professional	26	$45.79	$53.43	$53.43
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.58 / $137.84 / $137.84	Professional	TC	$114.58	$137.84	$137.84
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.71 / $108.34 / $159.46	Professional		$32.71	$108.34	$159.46
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.95 / $38.58 / $112.39	Professional	26	$31.95	$38.58	$112.39
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.83 / $83.16 / $125.22	Professional	TC	$68.83	$83.16	$125.22
United Facility/Professional Professional Modifier Low / Median / High Price $72.75 / $130.97 / $240.70	Professional		$72.75	$130.97	$240.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.49 / $46.56 / $75.06	Professional	26	$30.49	$46.56	$75.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.59 / $82.29 / $161.25	Professional	TC	$29.59	$82.29	$161.25