Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.45 / $219.50 / $451.23	Facility		$57.45	$219.50	$451.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.18 / $9.19 / $47.57	Facility	26	$9.18	$9.19	$47.57
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.64 / $64.33 / $335.82	Facility	TC	$23.64	$64.33	$335.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.64 / $40.22 / $70.81	Professional		$30.64	$40.22	$70.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.74 / $10.82 / $16.66	Professional	26	$8.74	$10.82	$16.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $32.83 / $112.07 / $121.85	Professional	50	$32.83	$112.07	$121.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.90 / $27.48 / $40.67	Professional	TC	$21.90	$27.48	$40.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.14 / $30.78 / $53.45	Professional		$19.14	$30.78	$53.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.09 / $8.26 / $12.93	Professional	26	$5.09	$8.26	$12.93
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $54.65 / $120.66 / $1,061.20	Facility		$54.65	$120.66	$1,061.20
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $1,469.51 / $1,469.51 / $1,469.51	Facility	TC	$1,469.51	$1,469.51	$1,469.51
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.25 / $19.44 / $38.31	Professional		$16.25	$19.44	$38.31
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $15.85 / $105.30	Professional	26	$11.04	$15.85	$105.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.63 / $92.67 / $143.90	Facility		$75.63	$92.67	$143.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $51.33 / $84.71	Professional		$30.90	$51.33	$84.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.89 / $13.86 / $22.83	Professional	26	$7.89	$13.86	$22.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.61 / $37.09 / $61.01	Professional	TC	$22.61	$37.09	$61.01
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $46.79 / $57.69 / $78.59	Professional		$46.79	$57.69	$78.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $14.15 / $19.29	Professional	26	$12.09	$14.15	$19.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.27 / $43.54 / $59.30	Professional	TC	$36.27	$43.54	$59.30
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $215.52 / $258.52 / $458.84	Facility		$215.52	$258.52	$458.84
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $55.56 / $8,702.00 / $16,128.00	Facility	TC	$55.56	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.13 / $38.97 / $57.75	Professional		$33.13	$38.97	$57.75
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.88 / $39.99	Professional	26	$9.02	$10.88	$39.99
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $28.38 / $47.37	Professional	TC	$24.12	$28.38	$47.37
United Facility/Professional Facility Modifier Low / Median / High Price $168.12 / $168.12 / $168.12	Facility		$168.12	$168.12	$168.12
United Facility/Professional Professional Modifier Low / Median / High Price $31.08 / $44.46 / $75.69	Professional		$31.08	$44.46	$75.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.67 / $12.21 / $20.16	Professional	26	$7.67	$12.21	$20.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.17 / $32.60 / $54.85	Professional	TC	$22.17	$32.60	$54.85