Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $168.92 / $341.98 / $1,785.07	Facility		$168.92	$341.98	$1,785.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.14 / $61.14 / $71.09	Facility	26	$61.14	$61.14	$71.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.96 / $183.32 / $264.64	Professional		$140.96	$183.32	$264.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $49.20 / $82.09	Professional	26	$37.95	$49.20	$82.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.60 / $131.38 / $188.42	Professional	TC	$96.60	$131.38	$188.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $110.84 / $110.84 / $228.42	Professional		$110.84	$110.84	$228.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.49 / $40.49 / $62.96	Professional	26	$40.49	$40.49	$62.96
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $481.65 / $1,506.40 / $1,749.30	Facility		$481.65	$1,506.40	$1,749.30
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $157.44 / $157.44 / $415.75	Professional		$157.44	$157.44	$415.75
Cigna Facility/Professional Facility Modifier Low / Median / High Price $208.96 / $250.96 / $1,280.00	Facility		$208.96	$250.96	$1,280.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.62 / $252.74 / $466.53	Professional		$126.62	$252.74	$466.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.73 / $67.26 / $126.85	Professional	26	$29.73	$67.26	$126.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.89 / $188.88 / $338.32	Professional	TC	$96.89	$188.88	$338.32
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $150.38 / $195.58 / $254.10	Professional		$150.38	$195.58	$254.10
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.12 / $55.47 / $72.00	Professional	26	$43.12	$55.47	$72.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.26 / $140.11 / $182.10	Professional	TC	$107.26	$140.11	$182.10
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $348.62 / $380.40 / $432.50	Facility		$348.62	$380.40	$432.50
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.41 / $161.10 / $274.68	Professional		$113.41	$161.10	$274.68
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $38.15 / $161.38	Professional	26	$31.66	$38.15	$161.38
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $105.99 / $124.69 / $225.35	Professional	TC	$105.99	$124.69	$225.35
United Facility/Professional Professional Modifier Low / Median / High Price $100.59 / $194.51 / $372.57	Professional		$100.59	$194.51	$372.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.64 / $47.21 / $95.74	Professional	26	$29.64	$47.21	$95.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.86 / $143.24 / $262.69	Professional	TC	$74.86	$143.24	$262.69