Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $181.97 / $426.58	Facility		$53.70	$181.97	$426.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $31.62 / $57.54	Facility	26	$7.59	$31.62	$57.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.18 / $72.44 / $239.88	Facility	TC	$28.18	$72.44	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $35.48 / $100.00	Professional		$9.12	$35.48	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.88 / $39.81	Professional	26	$7.59	$12.88	$39.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.62 / $138.04 / $208.93	Professional	50	$18.62	$138.04	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $27.54 / $67.61	Professional	TC	$19.05	$27.54	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $30.20 / $48.98	Professional		$25.12	$30.20	$48.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $8.32 / $16.60	Professional	26	$6.76	$8.32	$16.60
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $41.69 / $41.69	Professional	50	$41.69	$41.69	$41.69
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $30.90 / $44.67	Professional	TC	$23.99	$30.90	$44.67
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $295.12 / $933.25	Facility		$199.53	$295.12	$933.25
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $26.92 / $67.61	Professional		$9.33	$26.92	$67.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $70.79 / $128.82	Facility		$66.07	$70.79	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $43.65 / $75.86	Professional		$26.92	$43.65	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $11.48 / $18.62	Professional	26	$6.76	$11.48	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $31.62 / $57.54	Professional	TC	$20.42	$31.62	$57.54
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $51.29 / $69.18	Professional		$42.66	$51.29	$69.18
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.75 / $16.22	Professional	26	$10.23	$11.75	$16.22
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $38.90 / $53.70	Professional	TC	$32.36	$38.90	$53.70
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $239.88 / $457.09	Facility		$28.18	$239.88	$457.09
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $9,332.54 / $25,118.86	Facility	TC	$23.44	$9,332.54	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $35.48 / $66.07	Professional		$30.20	$35.48	$66.07
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $8.91 / $19.95	Professional	26	$7.59	$8.91	$19.95
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $26.30 / $44.67	Professional	TC	$22.39	$26.30	$44.67
United Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $131.83 / $204.17	Facility		$117.49	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $37.15 / $63.10	Professional		$25.70	$37.15	$63.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $10.00 / $16.60	Professional	26	$6.31	$10.00	$16.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $26.92 / $46.77	Professional	TC	$18.62	$26.92	$46.77