Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $371.54 / $794.33	Facility		$162.18	$371.54	$794.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $112.20 / $204.17	Facility	26	$70.79	$112.20	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $117.49 / $269.15	Professional		$75.86	$117.49	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $34.67 / $89.13	Professional	26	$22.91	$34.67	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $87.10 / $194.98	Professional	TC	$51.29	$87.10	$194.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $85.11 / $107.15	Professional		$79.43	$85.11	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $28.84	Professional	26	$19.50	$24.55	$28.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $75.86	Professional	TC	$75.86	$75.86	$75.86
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $602.56	Facility		$426.58	$426.58	$602.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $316.23 / $436.52	Facility		$234.42	$316.23	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $141.25 / $245.47	Professional		$81.28	$141.25	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $38.02 / $64.57	Professional	26	$19.50	$38.02	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $117.49 / $213.80	Professional	TC	$48.98	$117.49	$213.80
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $141.25 / $190.55	Professional		$125.89	$141.25	$190.55
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $30.90 / $40.74	Professional	26	$27.54	$30.90	$40.74
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $112.20 / $147.91	Professional	TC	$97.72	$112.20	$147.91
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $724.44 / $10,471.29	Facility		$95.50	$724.44	$10,471.29
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $229.09	Professional		$95.50	$112.20	$229.09
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $26.92 / $58.88	Professional	26	$22.91	$26.92	$58.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $85.11 / $169.82	Professional	TC	$72.44	$85.11	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $97.72 / $177.83	Professional		$66.07	$97.72	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $26.30 / $43.65	Professional	26	$18.20	$26.30	$43.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $75.86 / $138.04	Professional	TC	$45.71	$75.86	$138.04