Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.88 / $421.22 / $1,269.14	Facility		$125.88	$421.22	$1,269.14
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.94 / $24.94 / $34.90	Facility	26	$24.94	$24.94	$34.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $116.90 / $251.48 / $530.77	Facility	TC	$116.90	$251.48	$530.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.93 / $126.53 / $315.77	Professional		$43.93	$126.53	$315.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.87 / $23.73 / $80.84	Professional	26	$19.87	$23.73	$80.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.84 / $106.57 / $187.48	Professional	TC	$88.84	$106.57	$187.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.29 / $101.06 / $201.04	Professional		$76.29	$101.06	$201.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.35 / $17.53 / $38.50	Professional	26	$15.35	$17.53	$38.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $73.48 / $73.48 / $73.48	Professional	TC	$73.48	$73.48	$73.48
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $450.04 / $1,385.04 / $10,359.67	Facility		$450.04	$1,385.04	$10,359.67
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $22.41 / $74.80 / $240.75	Professional		$22.41	$74.80	$240.75
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $21.80 / $33.65 / $61.95	Professional	26	$21.80	$33.65	$61.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $231.05 / $242.64 / $461.48	Facility		$231.05	$242.64	$461.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.08 / $185.69 / $335.05	Professional		$114.08	$185.69	$335.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $29.32 / $55.67	Professional	26	$18.20	$29.32	$55.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.22 / $156.83 / $275.55	Professional	TC	$93.22	$156.83	$275.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.63 / $181.39 / $374.26	Professional		$138.63	$181.39	$374.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.79 / $29.87 / $62.44	Professional	26	$22.79	$29.87	$62.44
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $113.80 / $151.54 / $311.81	Professional	TC	$113.80	$151.54	$311.81
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $236.93 / $258.52 / $493.06	Facility		$236.93	$258.52	$493.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.47 / $132.69 / $210.18	Professional		$99.47	$132.69	$210.18
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.25 / $20.29 / $161.88	Professional	26	$17.25	$20.29	$161.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.95 / $102.50 / $176.11	Professional	TC	$80.95	$102.50	$176.11
United Facility/Professional Professional Modifier Low / Median / High Price $93.29 / $141.61 / $272.33	Professional		$93.29	$141.61	$272.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.96 / $24.26 / $43.58	Professional	26	$15.96	$24.26	$43.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.95 / $118.14 / $226.79	Professional	TC	$80.95	$118.14	$226.79