Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.34 / $252.95 / $840.60	Facility		$123.34	$252.95	$840.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.50 / $45.50 / $385.19	Facility	26	$32.50	$45.50	$385.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $128.06 / $427.80	Professional		$95.26	$128.06	$427.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.73 / $38.86 / $131.41	Professional	26	$30.73	$38.86	$131.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.86 / $87.95 / $172.57	Professional	TC	$64.86	$87.95	$172.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $68.98 / $99.73 / $171.71	Professional		$68.98	$99.73	$171.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.32 / $34.18 / $70.37	Professional	26	$28.32	$34.18	$70.37
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $172.92 / $498.95 / $5,462.64	Facility		$172.92	$498.95	$5,462.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $138.91 / $231.52	Professional		$41.40	$138.91	$231.52
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $43.02 / $61.99 / $108.10	Professional	26	$43.02	$61.99	$108.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.07 / $231.05 / $308.74	Facility		$194.07	$231.05	$308.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.20 / $160.77 / $256.38	Professional		$92.20	$160.77	$256.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $51.31 / $86.24	Professional	26	$27.80	$51.31	$86.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.18 / $109.30 / $186.57	Professional	TC	$63.18	$109.30	$186.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $132.15 / $160.09 / $274.87	Professional		$132.15	$160.09	$274.87
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.63 / $50.26 / $337.59	Professional	26	$41.63	$50.26	$337.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.51 / $109.83 / $337.59	Professional	TC	$90.51	$109.83	$337.59
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $249.00 / $258.52 / $493.06	Facility		$249.00	$258.52	$493.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.58 / $120.39 / $194.59	Professional		$96.58	$120.39	$194.59
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.60 / $39.27 / $128.31	Professional	26	$32.60	$39.27	$128.31
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.73 / $86.23 / $142.99	Professional	TC	$69.73	$86.23	$142.99
United Facility/Professional Professional Modifier Low / Median / High Price $89.20 / $137.75 / $238.06	Professional		$89.20	$137.75	$238.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.95 / $44.08 / $73.48	Professional	26	$27.95	$44.08	$73.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.07 / $94.30 / $163.57	Professional	TC	$61.07	$94.30	$163.57