Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $78.06 / $206.37 / $620.58	Facility		$78.06	$206.37	$620.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $7.52 / $22.10	Facility	26	$6.83	$7.52	$22.10
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.53 / $69.20 / $291.93	Facility	TC	$21.53	$69.20	$291.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.53 / $39.68 / $104.81	Professional		$11.53	$39.68	$104.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $8.94 / $34.00	Professional	26	$6.84	$8.94	$34.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.85 / $140.00 / $219.89	Professional	50	$17.85	$140.00	$219.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.25 / $30.06 / $61.97	Professional	TC	$21.25	$30.06	$61.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.10 / $30.70 / $45.36	Professional		$19.10	$30.70	$45.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $7.51 / $15.47	Professional	26	$6.14	$7.51	$15.47
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $43.99 / $246.40 / $2,250.17	Facility		$43.99	$246.40	$2,250.17
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $2,402.64 / $2,402.64 / $2,402.64	Facility	TC	$2,402.64	$2,402.64	$2,402.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $12.00 / $43.23 / $107.29	Professional		$12.00	$43.23	$107.29
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $14.39 / $24.80	Professional	26	$8.84	$14.39	$24.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.40 / $98.46 / $153.88	Facility		$81.40	$98.46	$153.88
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 $13.86 / $13.86 / $13.86	Facility	TC	$13.86	$13.86	$13.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.03 / $46.30 / $80.62	Professional		$30.03	$46.30	$80.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $10.44 / $17.59	Professional	26	$6.12	$10.44	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.54 / $31.09 / $56.04	Professional	TC	$21.54	$31.09	$56.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.44 / $53.65 / $67.52	Professional		$42.44	$53.65	$67.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.48 / $11.05 / $67.52	Professional	26	$9.48	$11.05	$67.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.02 / $46.86 / $67.52	Professional	TC	$39.02	$46.86	$67.52
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $178.45 / $206.18 / $214.08	Facility		$178.45	$206.18	$214.08
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $44.85 / $56.06 / $16,128.00	Facility	TC	$44.85	$56.06	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $38.89 / $55.97	Professional		$32.36	$38.89	$55.97
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.04 / $8.30 / $28.64	Professional	26	$7.04	$8.30	$28.64
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.33 / $29.80 / $43.39	Professional	TC	$25.33	$29.80	$43.39
United Facility/Professional Professional Modifier Low / Median / High Price $25.98 / $39.39 / $69.64	Professional		$25.98	$39.39	$69.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.04 / $9.02 / $14.86	Professional	26	$6.04	$9.02	$14.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.65 / $30.82 / $56.25	Professional	TC	$20.65	$30.82	$56.25