Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $55.92 / $184.68 / $604.07	Facility		$55.92	$184.68	$604.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $6.84 / $22.10	Facility	26	$6.83	$6.84	$22.10
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.10 / $62.38 / $274.04	Facility	TC	$22.10	$62.38	$274.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.20 / $34.40 / $87.58	Professional		$12.20	$34.40	$87.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $8.71 / $25.44	Professional	26	$6.84	$8.71	$25.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $30.03 / $170.96 / $192.55	Professional	50	$30.03	$170.96	$192.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.44 / $24.59 / $40.82	Professional	TC	$17.44	$24.59	$40.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.13 / $24.37 / $35.99	Professional		$15.13	$24.37	$35.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $7.35 / $13.86	Professional	26	$6.14	$7.35	$13.86
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $45.50 / $165.32 / $2,650.86	Facility		$45.50	$165.32	$2,650.86
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $2,493.46 / $2,493.46 / $2,493.46	Facility	TC	$2,493.46	$2,493.46	$2,493.46
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $12.00 / $36.74 / $84.85	Professional		$12.00	$36.74	$84.85
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $13.62 / $24.80	Professional	26	$9.96	$13.62	$24.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.82 / $74.94 / $114.14	Facility		$60.82	$74.94	$114.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.76 / $5.76 / $5.76	Facility	26	$5.76	$5.76	$5.76
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 $25.48 / $41.50 / $69.44	Professional		$25.48	$41.50	$69.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $10.42 / $17.59	Professional	26	$6.12	$10.42	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.44 / $28.93 / $50.49	Professional	TC	$18.44	$28.93	$50.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $38.32 / $45.59 / $62.30	Professional		$38.32	$45.59	$62.30
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.48 / $11.05 / $15.16	Professional	26	$9.48	$11.05	$15.16
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.79 / $34.54 / $47.14	Professional	TC	$28.79	$34.54	$47.14
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $178.45 / $214.08 / $379.92	Facility		$178.45	$214.08	$379.92
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $55.26 / $8,702.00 / $16,128.00	Facility	TC	$55.26	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.72 / $30.50 / $49.27	Professional		$25.72	$30.50	$49.27
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.04 / $8.27 / $14.61	Professional	26	$7.04	$8.27	$14.61
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.68 / $22.84 / $39.19	Professional	TC	$18.68	$22.84	$39.19
United Facility/Professional Professional Modifier Low / Median / High Price $25.13 / $34.35 / $59.66	Professional		$25.13	$34.35	$59.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.22 / $9.52 / $15.80	Professional	26	$6.22	$9.52	$15.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.28 / $24.96 / $44.14	Professional	TC	$18.28	$24.96	$44.14