Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $178.65 / $479.00 / $1,111.86	Facility		$178.65	$479.00	$1,111.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.89 / $24.90 / $34.85	Facility	26	$24.89	$24.90	$34.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.27 / $167.78 / $302.06	Professional		$120.27	$167.78	$302.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $22.53 / $37.52	Professional	26	$19.73	$22.53	$37.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.65 / $72.52 / $121.60	Professional	52	$59.65	$72.52	$121.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.28 / $146.75 / $238.50	Professional	TC	$99.28	$146.75	$238.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.91 / $117.42 / $152.82	Professional		$85.91	$117.42	$152.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $18.78 / $20.04	Professional	26	$17.07	$18.78	$20.04
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $464.77 / $7,386.02 / $12,561.50	Facility		$464.77	$7,386.02	$12,561.50
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $23.09 / $208.25 / $282.00	Professional		$23.09	$208.25	$282.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $225.02 / $268.88 / $511.49	Facility		$225.02	$268.88	$511.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.58 / $208.47 / $402.43	Professional		$125.58	$208.47	$402.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.28 / $29.27 / $55.67	Professional	26	$18.28	$29.27	$55.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.35 / $173.87 / $307.68	Professional	TC	$104.35	$173.87	$307.68
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $150.87 / $199.39 / $413.38	Professional		$150.87	$199.39	$413.38
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.64 / $30.25 / $64.77	Professional	26	$23.64	$30.25	$64.77
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.23 / $169.13 / $348.61	Professional	TC	$127.23	$169.13	$348.61
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $366.35 / $380.40 / $824.88	Facility		$366.35	$380.40	$824.88
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.23 / $146.07 / $246.48	Professional		$111.23	$146.07	$246.48
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.12 / $23.34 / $208.79	Professional	26	$17.12	$23.34	$208.79
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.10 / $110.71 / $235.41	Professional	TC	$94.10	$110.71	$235.41
United Facility/Professional Professional Modifier Low / Median / High Price $106.55 / $156.75 / $297.99	Professional		$106.55	$156.75	$297.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.16 / $23.76 / $44.19	Professional	26	$16.16	$23.76	$44.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.92 / $130.44 / $240.00	Professional	TC	$88.92	$130.44	$240.00