Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $660.69 / $1,778.28	Facility		$269.15	$660.69	$1,778.28
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $67.61 / $234.42	Facility	26	$36.31	$67.61	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $489.78	Professional		$162.18	$229.09	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $128.82	Professional	26	$34.67	$50.12	$128.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $169.82 / $389.05	Professional	TC	$131.83	$169.82	$389.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $141.25 / $190.55	Professional		$123.03	$141.25	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $37.15 / $54.95	Professional	26	$28.84	$37.15	$54.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	TC	$123.03	$123.03	$123.03
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $194.98 / $354.81	Professional		$40.74	$194.98	$354.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $354.81 / $630.96	Facility		$354.81	$354.81	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $467.74	Professional		$173.78	$269.15	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $81.28	Professional	26	$32.36	$45.71	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $380.19	Professional	TC	$134.90	$213.80	$380.19
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $229.09 / $363.08	Professional		$213.80	$229.09	$363.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $46.77 / $74.13	Professional	26	$43.65	$46.77	$74.13
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $181.97 / $288.40	Professional	TC	$169.82	$181.97	$288.40
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $977.24 / $13,803.84	Facility		$134.90	$977.24	$13,803.84
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $223.87 / $436.52	Professional		$158.49	$223.87	$436.52
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $75.86	Professional	26	$30.20	$42.66	$75.86
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $181.97 / $371.54	Professional	TC	$125.89	$181.97	$371.54
United Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $173.78 / $1,000.00	Facility		$34.67	$173.78	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $371.54	Professional		$138.04	$199.53	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $70.79	Professional	26	$26.92	$40.74	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $169.82 / $302.00	Professional	TC	$112.20	$169.82	$302.00