Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $204.17 / $645.65	Facility		$56.23	$204.17	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $11.22 / $52.48	Facility	26	$6.76	$11.22	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $69.18 / $218.78	Facility	TC	$28.84	$69.18	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $35.48 / $123.03	Professional		$9.55	$35.48	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.49 / $38.02	Professional	26	$7.08	$13.49	$38.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.20 / $93.33 / $213.80	Professional	50	$30.20	$93.33	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $32.36 / $83.18	Professional	TC	$19.05	$32.36	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $26.30 / $35.48	Professional		$20.89	$26.30	$35.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.94 / $14.45	Professional	26	$6.46	$7.94	$14.45
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $30.20 / $30.20 / $38.02	Professional	50	$30.20	$30.20	$38.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $21.38 / $31.62	Professional	TC	$14.45	$21.38	$31.62
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $331.13 / $446.68 / $831.76	Facility		$331.13	$446.68	$831.76
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $15.14 / $70.79	Professional		$9.12	$15.14	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $64.57 / $114.82	Facility		$60.26	$64.57	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $5.75 / $5.75	Facility	26	$5.75	$5.75	$5.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $15.49 / $15.49 / $15.49	Facility	TC	$15.49	$15.49	$15.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $41.69 / $70.79	Professional		$26.92	$41.69	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $17.78	Professional	26	$6.46	$10.72	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $28.84 / $50.12	Professional	TC	$18.62	$28.84	$50.12
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $64.57	Professional		$39.81	$46.77	$64.57
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $11.48 / $15.49	Professional	26	$9.77	$11.48	$15.49
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $35.48 / $48.98	Professional	TC	$29.51	$35.48	$48.98
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $245.47 / $9,772.37	Facility		$44.67	$245.47	$9,772.37
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $8,709.64 / $25,118.86	Facility	TC	$30.20	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $31.62 / $64.57	Professional		$26.92	$31.62	$64.57
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.51 / $18.62	Professional	26	$7.24	$8.51	$18.62
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $22.91 / $51.29	Professional	TC	$19.50	$22.91	$51.29
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $131.83 / $204.17	Facility		$81.28	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $34.67 / $58.88	Professional		$23.99	$34.67	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.12 / $15.85	Professional	26	$6.03	$9.12	$15.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $43.65	Professional	TC	$17.38	$25.12	$43.65