Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.83 / $8.84 / $48.89	Facility	26	$8.83	$8.84	$48.89
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.33 / $91.36 / $415.83	Facility	TC	$24.33	$91.36	$415.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.23 / $46.72 / $140.00	Professional		$19.23	$46.72	$140.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.68 / $11.79 / $32.46	Professional	26	$8.68	$11.79	$32.46
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $155.52 / $243.37 / $263.10	Professional	50	$155.52	$243.37	$263.10
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.18 / $21.16 / $25.70	Professional	52	$15.18	$21.16	$25.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.23 / $33.09 / $59.72	Professional	TC	$23.23	$33.09	$59.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.65 / $35.32 / $73.33	Professional		$30.65	$35.32	$73.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.10 / $10.48 / $21.89	Professional	26	$8.10	$10.48	$21.89
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $1,718.01 / $1,718.01 / $1,718.01	Facility	TC	$1,718.01	$1,718.01	$1,718.01
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $18.95 / $57.48 / $113.89	Professional		$18.95	$57.48	$113.89
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $18.00 / $34.76	Professional	26	$11.70	$18.00	$34.76
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $8.75 / $8.75 / $28.43	Professional	50	$8.75	$8.75	$28.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.17 / $7.17 / $7.17	Facility	26	$7.17	$7.17	$7.17
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.73 / $16.73 / $16.73	Facility	TC	$16.73	$16.73	$16.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.71 / $53.34 / $93.96	Professional		$34.71	$53.34	$93.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $13.86 / $23.47	Professional	26	$7.83	$13.86	$23.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.98 / $35.57 / $60.13	Professional	TC	$23.98	$35.57	$60.13
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $48.97 / $61.36 / $112.53	Professional		$48.97	$61.36	$112.53
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $14.63 / $112.53	Professional	26	$12.48	$14.63	$112.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.96 / $51.60 / $112.53	Professional	TC	$42.96	$51.60	$112.53
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $61.76 / $8,702.00 / $16,128.00	Facility	TC	$61.76	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.83 / $38.09 / $57.34	Professional		$28.83	$38.09	$57.34
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.61 / $32.72	Professional	26	$9.02	$10.61	$32.72
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.45 / $33.92 / $56.27	Professional	TC	$27.45	$33.92	$56.27
United Facility/Professional Professional Modifier Low / Median / High Price $31.09 / $46.99 / $80.80	Professional		$31.09	$46.99	$80.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $12.21 / $20.16	Professional	26	$8.08	$12.21	$20.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.22 / $33.65 / $61.30	Professional	TC	$24.22	$33.65	$61.30