Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.04 / $194.64 / $666.85	Facility		$70.04	$194.64	$666.85
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 $19.00 / $71.25 / $294.88	Facility	TC	$19.00	$71.25	$294.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.18 / $34.54 / $96.02	Professional		$11.18	$34.54	$96.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $8.94 / $34.85	Professional	26	$6.84	$8.94	$34.85
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $29.23 / $41.60 / $191.72	Professional	50	$29.23	$41.60	$191.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.57 / $25.73 / $54.42	Professional	TC	$18.57	$25.73	$54.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.27 / $27.78 / $37.88	Professional		$17.27	$27.78	$37.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.14 / $7.68 / $15.48	Professional	26	$6.14	$7.68	$15.48
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $29.07 / $50.51 / $50.51	Professional	50	$29.07	$50.51	$50.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.83 / $37.83 / $37.83	Professional	TC	$37.83	$37.83	$37.83
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $43.99 / $199.71 / $1,333.92	Facility		$43.99	$199.71	$1,333.92
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $2,422.23 / $2,422.23 / $2,422.23	Facility	TC	$2,422.23	$2,422.23	$2,422.23
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $13.17 / $42.41 / $78.75	Professional		$13.17	$42.41	$78.75
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $13.62 / $26.04	Professional	26	$8.84	$13.62	$26.04
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $68.25 / $68.25 / $68.25	Professional	50	$68.25	$68.25	$68.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $71.52 / $87.64 / $134.04	Facility		$71.52	$87.64	$134.04
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 $27.22 / $42.33 / $71.79	Professional		$27.22	$42.33	$71.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $10.39 / $17.59	Professional	26	$6.12	$10.39	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.25 / $29.11 / $47.70	Professional	TC	$19.25	$29.11	$47.70
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $37.22 / $49.20 / $71.26	Professional		$37.22	$49.20	$71.26
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 $34.29 / $41.18 / $56.10	Professional	TC	$34.29	$41.18	$56.10
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.01 / $214.08 / $214.08	Facility		$39.01	$214.08	$214.08
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $48.76 / $8,702.00 / $16,128.00	Facility	TC	$48.76	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.04 / $34.17 / $48.23	Professional		$29.04	$34.17	$48.23
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.04 / $8.27 / $23.32	Professional	26	$7.04	$8.27	$23.32
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.01 / $26.57 / $41.17	Professional	TC	$22.01	$26.57	$41.17
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 $24.51 / $36.43 / $63.22	Professional		$24.51	$36.43	$63.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.19 / $9.52 / $16.23	Professional	26	$6.19	$9.52	$16.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.32 / $28.09 / $50.06	Professional	TC	$19.32	$28.09	$50.06