Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.94 / $263.44 / $782.42	Facility		$121.94	$263.44	$782.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.67 / $29.67 / $92.09	Facility	26	$29.67	$29.67	$92.09
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.29 / $187.19 / $415.99	Facility	TC	$81.29	$187.19	$415.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.20 / $120.12 / $351.21	Professional		$88.20	$120.12	$351.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.81 / $35.90 / $116.06	Professional	26	$27.81	$35.90	$116.06
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.10 / $55.48 / $77.22	Professional	52	$44.10	$55.48	$77.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.39 / $84.90 / $146.84	Professional	TC	$60.39	$84.90	$146.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.43 / $85.02 / $108.12	Professional		$64.43	$85.02	$108.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.68 / $31.16 / $64.53	Professional	26	$25.68	$31.16	$64.53
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $77.77 / $196.53 / $1,289.68	Facility		$77.77	$196.53	$1,289.68
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $2,646.33 / $2,646.33 / $2,646.33	Facility	TC	$2,646.33	$2,646.33	$2,646.33
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $51.06 / $125.45 / $212.16	Professional		$51.06	$125.45	$212.16
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $56.54 / $103.83	Professional	26	$40.33	$56.54	$103.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $181.82 / $228.47 / $291.44	Facility		$181.82	$228.47	$291.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.43 / $150.54 / $247.12	Professional		$85.43	$150.54	$247.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.44 / $46.57 / $76.80	Professional	26	$25.44	$46.57	$76.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.83 / $104.23 / $183.53	Professional	TC	$61.83	$104.23	$183.53
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $123.52 / $149.49 / $256.92	Professional		$123.52	$149.49	$256.92
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.06 / $45.83 / $337.59	Professional	26	$38.06	$45.83	$337.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.47 / $103.66 / $337.59	Professional	TC	$85.47	$103.66	$337.59
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $208.63 / $215.52 / $293.94	Facility		$208.63	$215.52	$293.94
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $200.72 / $8,702.00 / $16,128.00	Facility	TC	$200.72	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.25 / $112.86 / $193.06	Professional		$92.25	$112.86	$193.06
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.27 / $35.26 / $118.53	Professional	26	$29.27	$35.26	$118.53
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.91 / $80.26 / $134.33	Professional	TC	$64.91	$80.26	$134.33
United Facility/Professional Facility Modifier Low / Median / High Price $143.22 / $174.35 / $272.43	Facility		$143.22	$174.35	$272.43
United Facility/Professional Professional Modifier Low / Median / High Price $82.53 / $120.08 / $219.11	Professional		$82.53	$120.08	$219.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.48 / $39.58 / $66.88	Professional	26	$25.48	$39.58	$66.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.80 / $81.63 / $152.22	Professional	TC	$55.80	$81.63	$152.22