Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $175.13 / $506.91	Facility		$40.00	$175.13	$506.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.25 / $6.25 / $20.30	Facility	26	$6.25	$6.25	$20.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.46 / $40.00 / $181.71	Facility	TC	$16.46	$40.00	$181.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.61 / $28.12 / $75.90	Professional		$10.61	$28.12	$75.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.25 / $8.00 / $25.17	Professional	26	$6.25	$8.00	$25.17
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $45.40 / $45.40 / $163.75	Professional	50	$45.40	$45.40	$163.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.99 / $20.64 / $37.07	Professional	TC	$13.99	$20.64	$37.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $13.59 / $20.21 / $37.79	Professional		$13.59	$20.21	$37.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.69 / $6.90 / $12.99	Professional	26	$5.69	$6.90	$12.99
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $45.50 / $165.32 / $1,033.02	Facility		$45.50	$165.32	$1,033.02
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $1,640.73 / $1,640.73 / $1,640.73	Facility	TC	$1,640.73	$1,640.73	$1,640.73
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.35 / $13.92 / $26.35	Professional		$8.35	$13.92	$26.35
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $12.52 / $23.85	Professional	26	$8.11	$12.52	$23.85
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.41 / $66.69 / $101.65	Facility		$53.41	$66.69	$101.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.27 / $5.27 / $5.27	Facility	26	$5.27	$5.27	$5.27
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 $22.55 / $35.97 / $59.40	Professional		$22.55	$35.97	$59.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.61 / $9.92 / $16.37	Professional	26	$5.61	$9.92	$16.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.46 / $24.30 / $40.07	Professional	TC	$15.46	$24.30	$40.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $32.47 / $40.89 / $55.97	Professional		$32.47	$40.89	$55.97
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.73 / $10.15 / $13.96	Professional	26	$8.73	$10.15	$13.96
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.64 / $30.75 / $42.01	Professional	TC	$25.64	$30.75	$42.01
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.15 / $214.08 / $408.26	Facility		$33.15	$214.08	$408.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.44 / $8,702.00 / $16,128.00	Facility	TC	$41.44	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.84 / $29.39 / $46.89	Professional		$23.84	$29.39	$46.89
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.94 / $8.16 / $24.98	Professional	26	$6.94	$8.16	$24.98
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.17 / $20.20 / $35.65	Professional	TC	$17.17	$20.20	$35.65
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 $21.54 / $32.15 / $52.07	Professional		$21.54	$32.15	$52.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.68 / $9.16 / $15.17	Professional	26	$5.68	$9.16	$15.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.89 / $22.27 / $39.29	Professional	TC	$15.89	$22.27	$39.29