Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.19 / $200.20 / $625.29	Facility		$61.19	$200.20	$625.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $6.84 / $24.40	Facility	26	$6.83	$6.84	$24.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.76 / $54.08 / $285.97	Facility	TC	$16.76	$54.08	$285.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.13 / $32.18 / $94.68	Professional		$11.13	$32.18	$94.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.73 / $8.81 / $23.26	Professional	26	$6.73	$8.81	$23.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $104.52 / $104.52 / $208.50	Professional	50	$104.52	$104.52	$208.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.81 / $15.30 / $19.09	Professional	52	$11.81	$15.30	$19.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.77 / $22.73 / $48.28	Professional	TC	$16.77	$22.73	$48.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.73 / $25.33 / $34.45	Professional		$15.73	$25.33	$34.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $6.73 / $14.85	Professional	26	$5.88	$6.73	$14.85
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $33.03 / $33.03 / $38.00	Professional	50	$33.03	$33.03	$38.00
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $77.73 / $358.70 / $804.30	Facility		$77.73	$358.70	$804.30
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $3,511.52 / $3,511.52 / $3,511.52	Facility	TC	$3,511.52	$3,511.52	$3,511.52
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.72 / $39.20 / $64.00	Professional		$8.72	$39.20	$64.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.49 / $14.10 / $27.78	Professional	26	$8.49	$14.10	$27.78
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $6.57 / $6.57 / $66.30	Professional	50	$6.57	$6.57	$66.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.93 / $79.59 / $122.10	Facility		$64.93	$79.59	$122.10
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 $13.61 / $13.61 / $13.61	Facility	TC	$13.61	$13.61	$13.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.92 / $40.84 / $67.22	Professional		$25.92	$40.84	$67.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.88 / $10.48 / $18.23	Professional	26	$5.88	$10.48	$18.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.73 / $26.25 / $44.42	Professional	TC	$17.73	$26.25	$44.42
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $35.58 / $46.06 / $67.52	Professional		$35.58	$46.06	$67.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.11 / $10.61 / $67.52	Professional	26	$9.11	$10.61	$67.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.76 / $36.90 / $67.52	Professional	TC	$30.76	$36.90	$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 $43.06 / $8,702.00 / $16,128.00	Facility	TC	$43.06	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.86 / $32.78 / $47.92	Professional		$27.86	$32.78	$47.92
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $7.97 / $29.98	Professional	26	$6.77	$7.97	$29.98
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.10 / $25.48 / $39.47	Professional	TC	$21.10	$25.48	$39.47
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 $23.54 / $36.09 / $61.16	Professional		$23.54	$36.09	$61.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.80 / $9.16 / $15.60	Professional	26	$5.80	$9.16	$15.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.35 / $27.31 / $46.40	Professional	TC	$17.35	$27.31	$46.40