Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $247.24 / $1,160.46 / $4,184.72	Facility		$247.24	$1,160.46	$4,184.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.84 / $46.84 / $220.03	Facility	26	$46.84	$46.84	$220.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.46 / $197.03 / $286.27	Professional		$126.46	$197.03	$286.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.84 / $59.64 / $108.86	Professional	26	$46.84	$59.64	$108.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $63.07 / $77.37 / $133.19	Professional	52	$63.07	$77.37	$133.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.76 / $126.47 / $211.98	Professional	TC	$56.76	$126.47	$211.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.38 / $105.38 / $105.38	Professional		$105.38	$105.38	$105.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.58 / $65.84 / $77.01	Professional	26	$64.58	$65.84	$77.01
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $87.08 / $87.08 / $110.64	Professional		$87.08	$87.08	$110.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $170.20 / $213.86 / $367.79	Facility		$170.20	$213.86	$367.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.38 / $38.38 / $38.38	Facility	26	$38.38	$38.38	$38.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $260.58 / $605.13	Professional		$116.74	$260.58	$605.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $76.23 / $130.63	Professional	26	$53.20	$76.23	$130.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.60 / $163.82 / $539.83	Professional	TC	$54.60	$163.82	$539.83
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $172.38 / $201.40 / $551.65	Professional		$172.38	$201.40	$551.65
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.77 / $105.79 / $150.72	Professional	26	$92.77	$105.79	$150.72
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.61 / $95.61 / $130.13	Professional	TC	$79.61	$95.61	$130.13
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $7,369.96 / $7,652.20 / $14,593.52	Facility		$7,369.96	$7,652.20	$14,593.52
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.36 / $157.63 / $274.72	Professional		$103.36	$157.63	$274.72
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.18 / $80.20 / $127.58	Professional	26	$68.18	$80.20	$127.58
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.81 / $77.42 / $140.31	Professional	TC	$65.81	$77.42	$140.31
United Facility/Professional Professional Modifier Low / Median / High Price $119.50 / $217.22 / $470.36	Professional		$119.50	$217.22	$470.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.66 / $88.42 / $156.58	Professional	26	$49.66	$88.42	$156.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.80 / $99.96 / $289.83	Professional	TC	$52.80	$99.96	$289.83