Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $213.80 / $676.08	Facility		$70.79	$213.80	$676.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $11.22 / $52.48	Facility	26	$6.76	$11.22	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $74.13 / $295.12	Facility	TC	$26.30	$74.13	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $39.81 / $125.89	Professional		$9.77	$39.81	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $14.79 / $41.69	Professional	26	$7.59	$14.79	$41.69
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.30 / $91.20 / $208.93	Professional	50	$26.30	$91.20	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $36.31 / $107.15	Professional	TC	$19.95	$36.31	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $29.51 / $48.98	Professional		$22.39	$29.51	$48.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.13 / $15.85	Professional	26	$6.46	$8.13	$15.85
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $56.23 / $93.33	Professional	50	$42.66	$56.23	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.30 / $37.15	Professional	TC	$20.42	$26.30	$37.15
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $501.19 / $1,047.13	Facility		$245.47	$501.19	$1,047.13
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $15.14 / $61.66	Professional		$9.12	$15.14	$61.66
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $63.10 / $63.10 / $81.28	Professional	50	$63.10	$63.10	$81.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $74.13 / $134.90	Facility		$69.18	$74.13	$134.90
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 $13.80 / $13.80 / $13.80	Facility	TC	$13.80	$13.80	$13.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $42.66 / $75.86	Professional		$28.18	$42.66	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $17.78	Professional	26	$6.46	$10.72	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $29.51 / $51.29	Professional	TC	$19.50	$29.51	$51.29
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $52.48 / $67.61	Professional		$44.67	$52.48	$67.61
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $11.48 / $67.61	Professional	26	$9.77	$11.48	$67.61
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $41.69 / $67.61	Professional	TC	$34.67	$41.69	$67.61
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $323.59 / $3,890.45	Facility		$39.81	$323.59	$3,890.45
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $8,709.64 / $25,118.86	Facility	TC	$26.30	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $35.48 / $69.18	Professional		$30.20	$35.48	$69.18
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.51 / $18.62	Professional	26	$7.24	$8.51	$18.62
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $26.92 / $57.54	Professional	TC	$22.91	$26.92	$57.54
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 $24.55 / $35.48 / $63.10	Professional		$24.55	$35.48	$63.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.12 / $15.85	Professional	26	$6.03	$9.12	$15.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.92 / $47.86	Professional	TC	$18.20	$26.92	$47.86