Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.35 / $261.95 / $635.34	Facility		$117.35	$261.95	$635.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $73.18	Facility	26	$23.98	$23.98	$73.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $63.90 / $151.32 / $445.37	Facility	TC	$63.90	$151.32	$445.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.18 / $96.70 / $257.95	Professional		$71.18	$96.70	$257.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.91 / $28.90 / $93.56	Professional	26	$23.91	$28.90	$93.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.96 / $69.68 / $117.26	Professional	TC	$48.96	$69.68	$117.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.62 / $74.37 / $96.14	Professional		$56.62	$74.37	$96.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.61 / $24.17 / $51.50	Professional	26	$20.61	$24.17	$51.50
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $133.80 / $491.30 / $4,063.50	Facility		$133.80	$491.30	$4,063.50
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $125.90 / $293.91 / $2,741.38	Facility	TC	$125.90	$293.91	$2,741.38
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $30.33 / $101.82 / $173.12	Professional		$30.33	$101.82	$173.12
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $30.59 / $46.33 / $81.84	Professional	26	$30.59	$46.33	$81.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.25 / $185.03 / $277.14	Facility		$147.25	$185.03	$277.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.27 / $120.23 / $198.19	Professional		$69.27	$120.23	$198.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.45 / $37.26 / $61.48	Professional	26	$20.45	$37.26	$61.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.55 / $83.08 / $140.52	Professional	TC	$47.55	$83.08	$140.52
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $99.26 / $120.40 / $206.46	Professional		$99.26	$120.40	$206.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.33 / $36.59 / $63.09	Professional	26	$30.33	$36.59	$63.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.93 / $83.83 / $143.37	Professional	TC	$68.93	$83.83	$143.37
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $208.63 / $208.63 / $493.06	Facility		$208.63	$208.63	$493.06
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $160.08 / $8,702.00 / $16,128.00	Facility	TC	$160.08	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.51 / $89.23 / $143.50	Professional		$58.51	$89.23	$143.50
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.32 / $28.10 / $84.85	Professional	26	$23.32	$28.10	$84.85
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.20 / $64.94 / $117.61	Professional	TC	$55.20	$64.94	$117.61
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 $65.36 / $96.32 / $176.47	Professional		$65.36	$96.32	$176.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $31.54 / $53.30	Professional	26	$20.34	$31.54	$53.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.60 / $71.01 / $123.17	Professional	TC	$46.60	$71.01	$123.17