Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $285.92 / $890.68 / $2,238.71	Facility		$285.92	$890.68	$2,238.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.73 / $74.36 / $981.28	Facility	26	$67.73	$74.36	$981.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.93 / $244.81 / $556.04	Professional		$191.93	$244.81	$556.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.09 / $72.77 / $175.42	Professional	26	$61.09	$72.77	$175.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $175.12 / $285.89	Professional	TC	$129.22	$175.12	$285.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $171.87 / $204.75 / $343.74	Professional		$171.87	$204.75	$343.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.60 / $74.87 / $114.08	Professional	26	$60.60	$74.87	$114.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $88.57 / $88.57 / $88.57	Professional	TC	$88.57	$88.57	$88.57
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $1,311.75 / $3,711.60 / $21,241.58	Facility		$1,311.75	$3,711.60	$21,241.58
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $211.91 / $315.87 / $568.72	Professional		$211.91	$315.87	$568.72
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $147.91 / $182.58	Professional	26	$80.70	$147.91	$182.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $276.98 / $1,457.93 / $3,087.43	Facility		$276.98	$1,457.93	$3,087.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.00 / $318.33 / $638.76	Professional		$170.00	$318.33	$638.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.33 / $92.65 / $176.77	Professional	26	$66.33	$92.65	$176.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $140.28 / $222.76 / $425.47	Professional	TC	$140.28	$222.76	$425.47
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $225.93 / $294.33 / $604.86	Professional		$225.93	$294.33	$604.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $97.68 / $199.88	Professional	26	$75.65	$97.68	$199.88
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.80 / $196.65 / $404.97	Professional	TC	$147.80	$196.65	$404.97
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,221.69 / $1,283.84 / $1,333.03	Facility		$1,221.69	$1,283.84	$1,333.03
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.40 / $196.07 / $358.30	Professional		$165.40	$196.07	$358.30
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.49 / $68.06 / $236.14	Professional	26	$56.49	$68.06	$236.14
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.16 / $136.21 / $293.33	Professional	TC	$110.16	$136.21	$293.33
United Facility/Professional Professional Modifier Low / Median / High Price $185.90 / $278.44 / $476.33	Professional		$185.90	$278.44	$476.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.66 / $84.36 / $157.90	Professional	26	$60.66	$84.36	$157.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.99 / $175.95 / $340.47	Professional	TC	$120.99	$175.95	$340.47