Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $199.53 / $707.95	Facility		$77.62	$199.53	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $12.59 / $61.66	Facility	26	$7.41	$12.59	$61.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $79.43 / $218.78	Facility	TC	$28.84	$79.43	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $46.77 / $144.54	Professional		$9.77	$46.77	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $16.60 / $45.71	Professional	26	$8.13	$16.60	$45.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.95 / $83.18 / $204.17	Professional	50	$19.95	$83.18	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.02 / $109.65	Professional	TC	$23.99	$38.02	$109.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $33.88 / $56.23	Professional		$26.30	$33.88	$56.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.12 / $16.22	Professional	26	$7.08	$9.12	$16.22
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $48.98 / $91.20	Professional	50	$39.81	$48.98	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $28.84 / $38.02	Professional	TC	$22.39	$28.84	$38.02
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $512.86 / $794.33	Facility		$263.03	$512.86	$794.33
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $29.51 / $77.62	Professional		$12.88	$29.51	$77.62
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $7.41 / $23.99 / $93.33	Professional	50	$7.41	$23.99	$93.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $85.11 / $151.36	Facility		$79.43	$85.11	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.03 / $6.03 / $6.03	Facility	26	$6.03	$6.03	$6.03
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 $30.90 / $46.77 / $85.11	Professional		$30.90	$46.77	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.48 / $19.50	Professional	26	$7.08	$11.48	$19.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $33.11 / $57.54	Professional	TC	$21.38	$33.11	$57.54
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $60.26 / $72.44	Professional		$51.29	$60.26	$72.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $12.88 / $72.44	Professional	26	$10.96	$12.88	$72.44
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $47.86 / $72.44	Professional	TC	$39.81	$47.86	$72.44
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $245.47 / $467.74	Facility		$42.66	$245.47	$467.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $29.51 / $9,120.11 / $25,118.86	Facility	TC	$29.51	$9,120.11	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $39.81 / $79.43	Professional		$33.88	$39.81	$79.43
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.12 / $21.38	Professional	26	$7.76	$9.12	$21.38
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $30.90 / $60.26	Professional	TC	$26.30	$30.90	$60.26
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 $26.92 / $39.81 / $70.79	Professional		$26.92	$39.81	$70.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $9.77 / $17.38	Professional	26	$6.61	$9.77	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.20 / $53.70	Professional	TC	$20.42	$30.20	$53.70