Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $31.34 / $184.68 / $487.42	Facility		$31.34	$184.68	$487.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.25 / $6.25 / $21.23	Facility	26	$6.25	$6.25	$21.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.14 / $36.47 / $183.00	Facility	TC	$16.14	$36.47	$183.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.20 / $30.26 / $79.79	Professional		$20.20	$30.26	$79.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.25 / $7.91 / $22.26	Professional	26	$6.25	$7.91	$22.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $14.51 / $81.59 / $184.75	Professional	50	$14.51	$81.59	$184.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $10.13 / $13.89 / $23.81	Professional	52	$10.13	$13.89	$23.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.09 / $20.39 / $38.27	Professional	TC	$15.09	$20.39	$38.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.30 / $23.39 / $40.47	Professional		$20.30	$23.39	$40.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $7.05 / $16.47	Professional	26	$5.88	$7.05	$16.47
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $35.08 / $35.08 / $35.08	Professional	50	$35.08	$35.08	$35.08
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $476.85 / $476.85 / $476.85	Facility		$476.85	$476.85	$476.85
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $22.75 / $57.83 / $68.25	Professional		$22.75	$57.83	$68.25
AmeriHealth Facility/Professional Professional Modifier 52 Low / Median / High Price $21.08 / $21.08 / $21.08	Professional	52	$21.08	$21.08	$21.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.35 / $71.54 / $109.57	Facility		$58.35	$71.54	$109.57
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 $12.86 / $12.86 / $12.86	Facility	TC	$12.86	$12.86	$12.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.58 / $36.61 / $61.23	Professional		$23.58	$36.61	$61.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $9.97 / $16.54	Professional	26	$5.88	$9.97	$16.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.73 / $24.66 / $39.61	Professional	TC	$15.73	$24.66	$39.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $32.07 / $43.63 / $59.81	Professional		$32.07	$43.63	$59.81
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 $27.61 / $33.11 / $45.21	Professional	TC	$27.61	$33.11	$45.21
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $233.95 / $258.52 / $458.84	Facility		$233.95	$258.52	$458.84
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $40.61 / $8,702.00 / $16,128.00	Facility	TC	$40.61	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.30 / $26.25 / $39.64	Professional		$19.30	$26.25	$39.64
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $7.96 / $22.44	Professional	26	$6.77	$7.96	$22.44
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.38 / $21.62 / $38.14	Professional	TC	$18.38	$21.62	$38.14
United Facility/Professional Facility Modifier Low / Median / High Price $143.22 / $168.12 / $272.43	Facility		$143.22	$168.12	$272.43
United Facility/Professional Professional Modifier Low / Median / High Price $22.09 / $30.68 / $54.02	Professional		$22.09	$30.68	$54.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.92 / $9.10 / $15.13	Professional	26	$5.92	$9.10	$15.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.55 / $22.92 / $41.11	Professional	TC	$15.55	$22.92	$41.11