Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.80 / $190.95 / $391.44	Facility		$53.80	$190.95	$391.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $7.51 / $38.89	Facility	26	$7.50	$7.51	$38.89
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.39 / $56.69 / $273.18	Facility	TC	$19.39	$56.69	$273.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.36 / $33.06 / $89.24	Professional		$12.36	$33.06	$89.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.17 / $9.09 / $25.76	Professional	26	$7.17	$9.09	$25.76
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $18.02 / $53.82 / $195.28	Professional	50	$18.02	$53.82	$195.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.98 / $22.83 / $39.63	Professional	TC	$17.98	$22.83	$39.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $16.51 / $26.58 / $36.10	Professional		$16.51	$26.58	$36.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.81 / $14.69	Professional	26	$5.89	$7.81	$14.69
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $48.54 / $198.30 / $1,277.64	Facility		$48.54	$198.30	$1,277.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $15.76 / $58.50 / $67.17	Professional		$15.76	$58.50	$67.17
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $12.85 / $86.29	Professional	26	$8.94	$12.85	$86.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.58 / $81.59 / $126.69	Facility		$66.58	$81.59	$126.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.03 / $43.17 / $70.90	Professional		$26.03	$43.17	$70.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.41 / $11.24 / $18.62	Professional	26	$6.41	$11.24	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.62 / $31.46 / $50.30	Professional	TC	$19.62	$31.46	$50.30
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $40.08 / $49.80 / $68.00	Professional		$40.08	$49.80	$68.00
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.85 / $11.48 / $15.74	Professional	26	$9.85	$11.48	$15.74
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.93 / $38.33 / $52.26	Professional	TC	$31.93	$38.33	$52.26
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $214.08 / $214.08 / $408.26	Facility		$214.08	$214.08	$408.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $44.94 / $8,702.00 / $16,128.00	Facility	TC	$44.94	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.71 / $33.78 / $50.66	Professional		$28.71	$33.78	$50.66
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.31 / $8.60 / $22.41	Professional	26	$7.31	$8.60	$22.41
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.40 / $25.18 / $40.04	Professional	TC	$21.40	$25.18	$40.04
United Facility/Professional Professional Modifier Low / Median / High Price $25.90 / $38.38 / $65.95	Professional		$25.90	$38.38	$65.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.43 / $10.08 / $16.59	Professional	26	$6.43	$10.08	$16.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.22 / $28.07 / $47.58	Professional	TC	$18.22	$28.07	$47.58