Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $245.12 / $647.16 / $1,504.84	Facility		$245.12	$647.16	$1,504.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.20 / $36.20 / $50.67	Facility	26	$36.20	$36.20	$50.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.61 / $204.21 / $352.74	Professional		$169.61	$204.21	$352.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $36.20 / $66.31	Professional	26	$30.83	$36.20	$66.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $133.29 / $167.34 / $276.58	Professional	TC	$133.29	$167.34	$276.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $116.07 / $160.38 / $320.77	Professional		$116.07	$160.38	$320.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $35.54 / $36.22	Professional	26	$35.54	$35.54	$36.22
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $765.00 / $6,957.69 / $10,675.09	Facility		$765.00	$6,957.69	$10,675.09
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $169.74 / $296.27 / $575.63	Professional		$169.74	$296.27	$575.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $327.68 / $352.85 / $671.09	Facility		$327.68	$352.85	$671.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.30 / $284.75 / $544.26	Professional		$173.30	$284.75	$544.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $46.24 / $88.21	Professional	26	$31.85	$46.24	$88.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.28 / $219.40 / $448.57	Professional	TC	$138.28	$219.40	$448.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $208.79 / $274.66 / $572.08	Professional		$208.79	$274.66	$572.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.52 / $54.64 / $119.24	Professional	26	$43.52	$54.64	$119.24
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.27 / $220.02 / $452.84	Professional	TC	$165.27	$220.02	$452.84
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $489.90 / $565.99 / $668.15	Facility		$489.90	$565.99	$668.15
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $150.75 / $189.75 / $339.90	Professional		$150.75	$189.75	$339.90
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.43 / $35.79 / $199.56	Professional	26	$30.43	$35.79	$199.56
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.48 / $149.57 / $270.30	Professional	TC	$122.48	$149.57	$270.30
United Facility/Professional Professional Modifier Low / Median / High Price $138.00 / $213.67 / $397.26	Professional		$138.00	$213.67	$397.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.32 / $40.42 / $72.90	Professional	26	$27.32	$40.42	$72.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.55 / $181.74 / $344.13	Professional	TC	$117.55	$181.74	$344.13