Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $199.53 / $467.74	Facility		$75.86	$199.53	$467.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $38.90 / $69.18	Facility	26	$9.12	$38.90	$69.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $87.10 / $213.80	Facility	TC	$33.88	$87.10	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $51.29 / $158.49	Professional		$32.36	$51.29	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.45 / $37.15	Professional	26	$8.91	$14.45	$37.15
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $114.82 / $194.98	Professional	50	$38.02	$114.82	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $77.62	Professional	TC	$21.88	$31.62	$77.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $36.31 / $67.61	Professional		$26.92	$36.31	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $9.77 / $17.78	Professional	26	$8.13	$9.77	$17.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.84 / $38.90	Professional	TC	$23.44	$28.84	$38.90
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $31.62 / $47.86	Professional		$16.22	$31.62	$47.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $81.28 / $144.54	Facility		$75.86	$81.28	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $51.29 / $87.10	Professional		$30.90	$51.29	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $14.13 / $22.91	Professional	26	$8.32	$14.13	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $37.15 / $66.07	Professional	TC	$23.44	$37.15	$66.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $60.26 / $81.28	Professional		$50.12	$60.26	$81.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.45 / $19.95	Professional	26	$12.59	$14.45	$19.95
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $44.67 / $61.66	Professional	TC	$37.15	$44.67	$61.66
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $281.84 / $562.34	Facility		$44.67	$281.84	$562.34
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $9,120.11 / $25,118.86	Facility	TC	$28.84	$9,120.11	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $40.74 / $77.62	Professional		$34.67	$40.74	$77.62
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.96 / $24.55	Professional	26	$9.33	$10.96	$24.55
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $29.51 / $60.26	Professional	TC	$25.12	$29.51	$60.26
United Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $177.83 / $309.03	Facility		$144.54	$177.83	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $74.13	Professional		$30.20	$42.66	$74.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.30 / $20.42	Professional	26	$7.76	$12.30	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $30.90 / $54.95	Professional	TC	$21.88	$30.90	$54.95