Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.74 / $370.90 / $1,153.61	Facility		$125.74	$370.90	$1,153.61
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.78 / $21.79 / $30.50	Facility	26	$21.78	$21.79	$30.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.82 / $138.90 / $272.41	Professional		$113.82	$138.90	$272.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.45 / $22.76 / $49.80	Professional	26	$18.45	$22.76	$49.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.29 / $117.11 / $199.18	Professional	TC	$96.29	$117.11	$199.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.96 / $100.19 / $151.69	Professional		$60.96	$100.19	$151.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $19.05 / $41.64	Professional	26	$16.78	$19.05	$41.64
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $453.05 / $453.05 / $458.46	Facility		$453.05	$453.05	$458.46
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $24.39 / $24.39 / $24.39	Professional		$24.39	$24.39	$24.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $231.05 / $299.33 / $569.39	Facility		$231.05	$299.33	$569.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $139.27 / $226.07 / $424.65	Professional		$139.27	$226.07	$424.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.16 / $28.86 / $59.27	Professional	26	$19.16	$28.86	$59.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.89 / $189.04 / $358.52	Professional	TC	$116.89	$189.04	$358.52
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $153.13 / $202.84 / $419.60	Professional		$153.13	$202.84	$419.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.74 / $32.15 / $67.79	Professional	26	$24.74	$32.15	$67.79
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.38 / $170.69 / $351.79	Professional	TC	$128.38	$170.69	$351.79
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $233.95 / $258.52 / $525.08	Facility		$233.95	$258.52	$525.08
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.86 / $143.54 / $239.96	Professional		$112.86	$143.54	$239.96
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.75 / $22.06 / $170.74	Professional	26	$18.75	$22.06	$170.74
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.54 / $110.71 / $194.82	Professional	TC	$89.54	$110.71	$194.82
United Facility/Professional Professional Modifier Low / Median / High Price $119.43 / $178.05 / $297.79	Professional		$119.43	$178.05	$297.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.25 / $24.90 / $44.25	Professional	26	$16.25	$24.90	$44.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.24 / $150.21 / $289.92	Professional	TC	$99.24	$150.21	$289.92