Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.57 / $263.98 / $821.64	Facility		$118.57	$263.98	$821.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.92 / $27.87 / $69.48	Facility	26	$21.92	$27.87	$69.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.91 / $119.81 / $296.77	Professional		$92.91	$119.81	$296.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.76 / $27.24 / $77.87	Professional	26	$21.76	$27.24	$77.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.40 / $53.94 / $84.11	Professional	52	$45.40	$53.94	$84.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.59 / $87.35 / $167.79	Professional	TC	$69.59	$87.35	$167.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.17 / $103.84 / $118.36	Professional		$71.17	$103.84	$118.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $23.51 / $49.42	Professional	26	$19.82	$23.51	$49.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $107.82 / $107.82 / $107.82	Professional	TC	$107.82	$107.82	$107.82
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $124.38 / $535.50 / $6,512.40	Facility		$124.38	$535.50	$6,512.40
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $47.58 / $144.00 / $263.81	Professional		$47.58	$144.00	$263.81
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $31.06 / $47.38 / $83.13	Professional	26	$31.06	$47.38	$83.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $207.34 / $246.49 / $330.81	Facility		$207.34	$246.49	$330.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.94 / $153.80 / $262.93	Professional		$87.94	$153.80	$262.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $35.18 / $59.53	Professional	26	$19.73	$35.18	$59.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.19 / $116.65 / $207.10	Professional	TC	$65.19	$116.65	$207.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $106.40 / $152.69 / $262.12	Professional		$106.40	$152.69	$262.12
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.30 / $35.29 / $193.56	Professional	26	$29.30	$35.29	$193.56
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.72 / $117.41 / $201.18	Professional	TC	$96.72	$117.41	$201.18
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $258.52 / $293.94 / $560.62	Facility		$258.52	$293.94	$560.62
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.21 / $119.33 / $171.28	Professional		$92.21	$119.33	$171.28
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.50 / $27.12 / $129.34	Professional	26	$22.50	$27.12	$129.34
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.38 / $92.21 / $152.88	Professional	TC	$78.38	$92.21	$152.88
United Facility/Professional Facility Modifier Low / Median / High Price $143.22 / $174.35 / $272.43	Facility		$143.22	$174.35	$272.43
United Facility/Professional Professional Modifier Low / Median / High Price $73.19 / $118.14 / $219.20	Professional		$73.19	$118.14	$219.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $30.42 / $51.44	Professional	26	$19.89	$30.42	$51.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.19 / $96.15 / $169.37	Professional	TC	$63.19	$96.15	$169.37