Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $130.71 / $130.71 / $2,304.00	Facility		$130.71	$130.71	$2,304.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.56 / $13.56 / $40.77	Facility	26	$13.56	$13.56	$40.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.81 / $130.71 / $214.70	Professional		$103.81	$130.71	$214.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $21.46 / $32.17	Professional	26	$11.77	$21.46	$32.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.36 / $112.26 / $186.17	Professional	TC	$84.36	$112.26	$186.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.84 / $113.84 / $123.20	Professional		$113.84	$113.84	$123.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.24 / $22.24 / $22.24	Professional	26	$22.24	$22.24	$22.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $204.82 / $305.93 / $341.37	Facility		$204.82	$305.93	$341.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.69 / $229.41 / $446.35	Professional		$140.69	$229.41	$446.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.82 / $25.13 / $51.26	Professional	26	$13.82	$25.13	$51.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.93 / $191.01 / $401.58	Professional	TC	$117.93	$191.01	$401.58
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.80 / $176.89 / $264.72	Professional		$138.80	$176.89	$264.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.24 / $30.75 / $44.67	Professional	26	$23.24	$30.75	$44.67
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.55 / $154.07 / $218.69	Professional	TC	$115.55	$154.07	$218.69
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $215.52 / $258.52 / $525.08	Facility		$215.52	$258.52	$525.08
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.29 / $144.43 / $261.58	Professional		$108.29	$144.43	$261.58
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.73 / $22.48 / $97.82	Professional	26	$18.73	$22.48	$97.82
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.10 / $113.38 / $217.43	Professional	TC	$94.10	$113.38	$217.43
United Facility/Professional Professional Modifier Low / Median / High Price $118.53 / $174.68 / $345.80	Professional		$118.53	$174.68	$345.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.49 / $23.57 / $45.10	Professional	26	$11.49	$23.57	$45.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.67 / $153.12 / $292.43	Professional	TC	$97.67	$153.12	$292.43