Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $31.40 / $181.83 / $489.13	Facility		$31.40	$181.83	$489.13
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.98 / $5.98 / $21.23	Facility	26	$5.98	$5.98	$21.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.46 / $40.00 / $167.43	Facility	TC	$16.46	$40.00	$167.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.55 / $28.51 / $67.31	Professional		$18.55	$28.51	$67.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.98 / $7.89 / $21.54	Professional	26	$5.98	$7.89	$21.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $157.58 / $157.58 / $302.26	Professional	50	$157.58	$157.58	$302.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.93 / $21.27 / $32.86	Professional	TC	$14.93	$21.27	$32.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $13.59 / $20.21 / $29.58	Professional		$13.59	$20.21	$29.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.12 / $6.23 / $13.30	Professional	26	$4.12	$6.23	$13.30
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $43.99 / $114.90 / $1,788.39	Facility		$43.99	$114.90	$1,788.39
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $2,227.71 / $2,227.71 / $2,227.71	Facility	TC	$2,227.71	$2,227.71	$2,227.71
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.68 / $67.50 / $67.50	Professional		$8.68	$67.50	$67.50
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $9.58 / $13.08 / $22.91	Professional	26	$9.58	$13.08	$22.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $52.58 / $66.06 / $100.09	Facility		$52.58	$66.06	$100.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.04 / $5.04 / $5.04	Facility	26	$5.04	$5.04	$5.04
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $13.61 / $13.61 / $13.61	Facility	TC	$13.61	$13.61	$13.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.82 / $36.35 / $60.59	Professional		$22.82	$36.35	$60.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $9.60 / $16.32	Professional	26	$5.88	$9.60	$16.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.11 / $24.67 / $40.56	Professional	TC	$16.11	$24.67	$40.56
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $32.92 / $40.89 / $55.97	Professional		$32.92	$40.89	$55.97
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $10.61 / $14.60	Professional	26	$9.11	$10.61	$14.60
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.25 / $30.28 / $41.37	Professional	TC	$25.25	$30.28	$41.37
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $172.75 / $214.08 / $214.08	Facility		$172.75	$214.08	$214.08
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $8,702.00 / $8,702.00 / $16,128.00	Facility	TC	$8,702.00	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.64 / $28.24 / $43.40	Professional		$23.64	$28.24	$43.40
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $7.97 / $24.85	Professional	26	$6.77	$7.97	$24.85
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.86 / $20.37 / $33.24	Professional	TC	$16.86	$20.37	$33.24
United Facility/Professional Facility Modifier Low / Median / High Price $116.42 / $132.18 / $202.25	Facility		$116.42	$132.18	$202.25
United Facility/Professional Professional Modifier Low / Median / High Price $21.28 / $29.16 / $50.76	Professional		$21.28	$29.16	$50.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.67 / $9.11 / $15.17	Professional	26	$5.67	$9.11	$15.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.65 / $22.54 / $38.15	Professional	TC	$15.65	$22.54	$38.15