Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.31 / $278.02 / $1,189.32	Facility		$81.31	$278.02	$1,189.32
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.12 / $29.83 / $136.12	Facility	26	$27.12	$29.83	$136.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.83 / $87.22 / $228.41	Professional		$46.83	$87.22	$228.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $30.80 / $66.73	Professional	26	$25.70	$30.80	$66.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.62 / $45.60 / $184.73	Professional	TC	$21.62	$45.60	$184.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.16 / $42.48 / $98.70	Professional		$42.16	$42.48	$98.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $26.63 / $55.95	Professional	26	$23.34	$26.63	$55.95
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $266.89 / $3,499.25 / $5,418.00	Facility		$266.89	$3,499.25	$5,418.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $39.78 / $70.12 / $514.50	Professional		$39.78	$70.12	$514.50
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $35.50 / $48.83 / $78.90	Professional	26	$35.50	$48.83	$78.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $70.59 / $87.79 / $100.00	Facility		$70.59	$87.79	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.69 / $102.42 / $288.74	Professional		$45.69	$102.42	$288.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.80 / $41.48 / $68.25	Professional	26	$21.80	$41.48	$68.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.65 / $48.13 / $231.86	Professional	TC	$21.65	$48.13	$231.86
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $66.70 / $88.02 / $225.06	Professional		$66.70	$88.02	$225.06
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.70 / $39.54 / $225.06	Professional	26	$32.70	$39.54	$225.06
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.00 / $41.18 / $225.06	Professional	TC	$34.00	$41.18	$225.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.81 / $55.20 / $96.20	Professional		$29.81	$55.20	$96.20
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.22 / $30.35 / $56.53	Professional	26	$25.22	$30.35	$56.53
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.70 / $26.82 / $53.26	Professional	TC	$21.70	$26.82	$53.26
United Facility/Professional Professional Modifier Low / Median / High Price $53.93 / $100.99 / $186.37	Professional		$53.93	$100.99	$186.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.92 / $35.08 / $57.56	Professional	26	$21.92	$35.08	$57.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.72 / $35.22 / $161.00	Professional	TC	$21.72	$35.22	$161.00