Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $208.93 / $537.03	Facility		$97.72	$208.93	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $43.65 / $204.17	Facility	26	$26.92	$43.65	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $97.72 / $338.84	Professional		$51.29	$97.72	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $52.48 / $131.83	Professional	26	$28.18	$52.48	$131.83
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $67.61 / $181.97 / $630.96	Professional	50	$67.61	$181.97	$630.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $60.26 / $229.09	Professional	TC	$42.66	$60.26	$229.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $77.62 / $97.72	Professional		$58.88	$77.62	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $28.84 / $56.23	Professional	26	$24.55	$28.84	$56.23
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $114.82 / $204.17	Professional	50	$83.18	$114.82	$204.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $35.48 / $35.48	Professional	TC	$35.48	$35.48	$35.48
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $524.81 / $933.25	Facility		$309.03	$524.81	$933.25
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $97.72 / $204.17	Professional		$47.86	$97.72	$204.17
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $72.44 / $147.91 / $263.03	Professional	50	$72.44	$147.91	$263.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $141.25 / $263.03	Facility		$131.83	$141.25	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $117.49 / $186.21	Professional		$67.61	$117.49	$186.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $69.18	Professional	26	$25.70	$43.65	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $72.44 / $117.49	Professional	TC	$41.69	$72.44	$117.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $102.33 / $141.25	Professional		$97.72	$102.33	$141.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $37.15 / $51.29	Professional	26	$35.48	$37.15	$51.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $64.57 / $89.13	Professional	TC	$61.66	$64.57	$89.13
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $323.59 / $1,096.48	Facility		$100.00	$323.59	$1,096.48
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $75.86 / $169.82	Professional		$63.10	$75.86	$169.82
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $28.18 / $72.44	Professional	26	$23.44	$28.18	$72.44
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $120.23	Professional	TC	$38.90	$48.98	$120.23
United Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $131.83 / $234.42	Facility		$117.49	$131.83	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $91.20 / $165.96	Professional		$64.57	$91.20	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $34.67 / $60.26	Professional	26	$23.44	$34.67	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $57.54 / $104.71	Professional	TC	$40.74	$57.54	$104.71