Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.22 / $194.10 / $494.70	Facility		$39.22	$194.10	$494.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.25 / $8.11 / $20.93	Facility	26	$6.25	$8.11	$20.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.14 / $39.22 / $190.78	Facility	TC	$16.14	$39.22	$190.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.87 / $29.97 / $84.60	Professional		$17.87	$29.97	$84.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.25 / $7.84 / $17.28	Professional	26	$6.25	$7.84	$17.28
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $44.78 / $180.82 / $192.75	Professional	50	$44.78	$180.82	$192.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.05 / $14.24 / $18.64	Professional	52	$11.05	$14.24	$18.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.14 / $21.30 / $37.97	Professional	TC	$16.14	$21.30	$37.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.73 / $22.03 / $28.60	Professional		$20.73	$22.03	$28.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.22 / $6.35 / $14.26	Professional	26	$5.22	$6.35	$14.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.80 / $19.80 / $19.80	Professional	TC	$19.80	$19.80	$19.80
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $189.28 / $229.60 / $354.60	Facility		$189.28	$229.60	$354.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.76 / $27.95 / $61.98	Professional		$8.76	$27.95	$61.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.82 / $74.56 / $114.27	Facility		$60.82	$74.56	$114.27
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 $24.57 / $38.34 / $64.48	Professional		$24.57	$38.34	$64.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.66 / $9.92 / $16.37	Professional	26	$5.66	$9.92	$16.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.62 / $25.00 / $42.25	Professional	TC	$16.62	$25.00	$42.25
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $32.88 / $43.63 / $61.08	Professional		$32.88	$43.63	$61.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.73 / $10.15 / $13.96	Professional	26	$8.73	$10.15	$13.96
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.79 / $34.54 / $47.14	Professional	TC	$28.79	$34.54	$47.14
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $178.45 / $214.08 / $408.26	Facility		$178.45	$214.08	$408.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $41.44 / $8,702.00 / $16,128.00	Facility	TC	$41.44	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.36 / $31.01 / $44.19	Professional		$26.36	$31.01	$44.19
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.77 / $8.08 / $30.65	Professional	26	$6.77	$8.08	$30.65
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.59 / $23.66 / $37.14	Professional	TC	$19.59	$23.66	$37.14
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 $22.10 / $32.74 / $58.13	Professional		$22.10	$32.74	$58.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.72 / $8.78 / $15.13	Professional	26	$5.72	$8.78	$15.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.93 / $23.36 / $42.36	Professional	TC	$15.93	$23.36	$42.36