Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $249.51 / $868.00 / $2,243.15	Facility		$249.51	$868.00	$2,243.15
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.92 / $31.93 / $49.16	Facility	26	$31.92	$31.93	$49.16
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $183.28 / $269.50 / $979.46	Facility	TC	$183.28	$269.50	$979.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.49 / $239.17 / $430.00	Professional		$178.49	$239.17	$430.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.96 / $36.46 / $67.63	Professional	26	$26.96	$36.46	$67.63
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $215.21 / $215.21 / $215.21	Professional	50	$215.21	$215.21	$215.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.63 / $195.52 / $346.82	Professional	TC	$151.63	$195.52	$346.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.86 / $175.12 / $241.09	Professional		$139.86	$175.12	$241.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.19 / $30.44 / $52.60	Professional	26	$27.19	$30.44	$52.60
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $704.32 / $27,253.01 / $46,349.54	Facility		$704.32	$27,253.01	$46,349.54
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $66.26 / $349.51 / $636.63	Professional		$66.26	$349.51	$636.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $336.26 / $501.74 / $954.24	Facility		$336.26	$501.74	$954.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $228.90 / $369.25 / $722.13	Professional		$228.90	$369.25	$722.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.45 / $46.08 / $94.13	Professional	26	$29.45	$46.08	$94.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.32 / $308.50 / $617.27	Professional	TC	$194.32	$308.50	$617.27
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $273.62 / $363.27 / $749.72	Professional		$273.62	$363.27	$749.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.58 / $52.92 / $111.19	Professional	26	$40.58	$52.92	$111.19
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $233.04 / $310.33 / $638.53	Professional	TC	$233.04	$310.33	$638.53
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $474.24 / $489.90 / $1,120.74	Facility		$474.24	$489.90	$1,120.74
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.16 / $254.93 / $422.33	Professional		$204.16	$254.93	$422.33
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.31 / $35.65 / $282.88	Professional	26	$30.31	$35.65	$282.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.52 / $215.80 / $386.27	Professional	TC	$174.52	$215.80	$386.27
United Facility/Professional Professional Modifier Low / Median / High Price $185.78 / $287.77 / $505.86	Professional		$185.78	$287.77	$505.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.29 / $40.06 / $71.53	Professional	26	$25.29	$40.06	$71.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.81 / $254.44 / $455.72	Professional	TC	$165.81	$254.44	$455.72