Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $190.55 / $616.60	Facility		$54.95	$190.55	$616.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $10.23 / $52.48	Facility	26	$6.76	$10.23	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.42 / $58.88 / $154.88	Facility	TC	$20.42	$58.88	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $33.88 / $109.65	Professional		$8.91	$33.88	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.80 / $39.81	Professional	26	$7.08	$13.80	$39.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $72.44 / $173.78	Professional	50	$17.78	$72.44	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $27.54 / $70.79	Professional	TC	$15.85	$27.54	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $25.12 / $40.74	Professional		$19.50	$25.12	$40.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.24 / $12.88	Professional	26	$5.89	$7.24	$12.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $24.55 / $31.62	Professional	TC	$19.95	$24.55	$31.62
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $398.11 / $5,011.87	Facility		$234.42	$398.11	$5,011.87
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $7.24 / $13.80 / $61.66	Professional		$7.24	$13.80	$61.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $63.10 / $114.82	Facility		$58.88	$63.10	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $5.75 / $5.75	Facility	26	$5.75	$5.75	$5.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $13.49 / $13.49 / $13.49	Facility	TC	$13.49	$13.49	$13.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $38.02 / $64.57	Professional		$24.55	$38.02	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.00 / $16.60	Professional	26	$6.03	$10.00	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $24.55 / $42.66	Professional	TC	$16.22	$24.55	$42.66
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $44.67 / $61.66	Professional		$38.02	$44.67	$61.66
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $10.47 / $14.45	Professional	26	$8.91	$10.47	$14.45
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $34.67 / $46.77	Professional	TC	$28.84	$34.67	$46.77
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $239.88 / $2,041.74	Facility		$31.62	$239.88	$2,041.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $8,709.64 / $25,118.86	Facility	TC	$21.88	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $30.90 / $58.88	Professional		$26.30	$30.90	$58.88
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $7.76 / $18.20	Professional	26	$6.61	$7.76	$18.20
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $23.44 / $43.65	Professional	TC	$19.95	$23.44	$43.65
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 $21.38 / $30.90 / $56.23	Professional		$21.38	$30.90	$56.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $8.51 / $14.79	Professional	26	$5.62	$8.51	$14.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $40.74	Professional	TC	$15.85	$22.91	$40.74