Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $165.96 / $575.44	Facility		$41.69	$165.96	$575.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.31 / $10.23 / $50.12	Facility	26	$6.31	$10.23	$50.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $53.70 / $131.83	Facility	TC	$22.91	$53.70	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $30.90 / $97.72	Professional		$9.77	$30.90	$97.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $12.02 / $36.31	Professional	26	$6.76	$12.02	$36.31
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $72.44 / $190.55	Professional	50	$17.78	$72.44	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $25.70 / $64.57	Professional	TC	$15.85	$25.70	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $22.39 / $36.31	Professional		$17.78	$22.39	$36.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.24 / $13.18	Professional	26	$6.03	$7.24	$13.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $19.50 / $23.44	Professional	TC	$12.88	$19.50	$23.44
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $380.19 / $436.52	Facility		$251.19	$380.19	$436.52
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $13.80 / $33.11	Professional		$8.32	$13.80	$33.11
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $57.54 / $102.33	Facility		$53.70	$57.54	$102.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.25 / $5.25 / $5.25	Facility	26	$5.25	$5.25	$5.25
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $13.49 / $13.49 / $13.49	Facility	TC	$13.49	$13.49	$13.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $36.31 / $60.26	Professional		$23.44	$36.31	$60.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.00 / $16.60	Professional	26	$6.03	$10.00	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $40.74	Professional	TC	$15.85	$23.99	$40.74
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $41.69 / $56.23	Professional		$34.67	$41.69	$56.23
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $10.47 / $14.45	Professional	26	$8.91	$10.47	$14.45
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $30.90 / $42.66	Professional	TC	$25.70	$30.90	$42.66
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $239.88 / $467.74	Facility		$33.11	$239.88	$467.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $22.39 / $8,709.64 / $25,118.86	Facility	TC	$22.39	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $29.51 / $54.95	Professional		$24.55	$29.51	$54.95
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.13 / $16.60	Professional	26	$6.92	$8.13	$16.60
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $21.38 / $44.67	Professional	TC	$18.20	$21.38	$44.67
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 $20.89 / $30.20 / $52.48	Professional		$20.89	$30.20	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $8.71 / $15.14	Professional	26	$5.62	$8.71	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $21.38 / $38.90	Professional	TC	$15.14	$21.38	$38.90