Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $165.96 / $724.44	Facility		$61.66	$165.96	$724.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $12.30 / $61.66	Facility	26	$7.41	$12.30	$61.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.55 / $67.61 / $239.88	Facility	TC	$24.55	$67.61	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $39.81 / $112.20	Professional		$9.33	$39.81	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.88 / $41.69	Professional	26	$7.94	$12.88	$41.69
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.20 / $79.43 / $190.55	Professional	50	$30.20	$79.43	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $33.88 / $97.72	Professional	TC	$19.05	$33.88	$97.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $28.84 / $42.66	Professional		$21.88	$28.84	$42.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.71 / $16.60	Professional	26	$7.08	$8.71	$16.60
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $32.36 / $43.65 / $70.79	Professional	50	$32.36	$43.65	$70.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $24.55 / $35.48	Professional	TC	$18.20	$24.55	$35.48
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $331.13 / $549.54 / $1,174.90	Facility		$331.13	$549.54	$1,174.90
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $30.90 / $74.13	Professional		$9.77	$30.90	$74.13
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $74.13 / $74.13 / $74.13	Professional	50	$74.13	$74.13	$74.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $69.18 / $120.23	Facility		$64.57	$69.18	$120.23
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 $26.30 / $40.74 / $70.79	Professional		$26.30	$40.74	$70.79
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 $17.38 / $26.30 / $45.71	Professional	TC	$17.38	$26.30	$45.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $51.29 / $79.43	Professional		$42.66	$51.29	$79.43
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.30 / $79.43	Professional	26	$10.47	$12.30	$79.43
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $38.90 / $79.43	Professional	TC	$32.36	$38.90	$79.43
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $269.15 / $2,187.76	Facility		$34.67	$269.15	$2,187.76
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $8,709.64 / $25,118.86	Facility	TC	$23.44	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.88 / $64.57	Professional		$28.84	$33.88	$64.57
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 $20.89 / $24.55 / $47.86	Professional	TC	$20.89	$24.55	$47.86
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 $23.99 / $33.88 / $58.88	Professional		$23.99	$33.88	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $9.77 / $17.38	Professional	26	$6.46	$9.77	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $23.99 / $43.65	Professional	TC	$17.38	$23.99	$43.65