Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.70 / $209.45 / $657.64	Facility		$70.70	$209.45	$657.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $6.84 / $21.76	Facility	26	$6.83	$6.84	$21.76
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.00 / $73.90 / $322.37	Facility	TC	$19.00	$73.90	$322.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.53 / $36.38 / $111.60	Professional		$11.53	$36.38	$111.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $9.11 / $37.54	Professional	26	$6.84	$9.11	$37.54
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $51.68 / $200.20 / $351.57	Professional	50	$51.68	$200.20	$351.57
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.04 / $16.32 / $20.51	Professional	52	$12.04	$16.32	$20.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.61 / $25.82 / $52.63	Professional	TC	$18.61	$25.82	$52.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.14 / $28.50 / $36.85	Professional		$20.14	$28.50	$36.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.66 / $7.51 / $16.52	Professional	26	$5.66	$7.51	$16.52
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $30.21 / $30.21 / $30.21	Professional	50	$30.21	$30.21	$30.21
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $44.95 / $261.56 / $3,070.44	Facility		$44.95	$261.56	$3,070.44
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $1,340.44 / $1,340.44 / $1,340.44	Facility	TC	$1,340.44	$1,340.44	$1,340.44
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $14.74 / $45.90 / $82.04	Professional		$14.74	$45.90	$82.04
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $14.39 / $24.80	Professional	26	$8.84	$14.39	$24.80
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $62.94 / $81.00 / $81.00	Professional	50	$62.94	$81.00	$81.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.87 / $85.63 / $131.50	Facility		$69.87	$85.63	$131.50
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 $27.53 / $42.27 / $71.80	Professional		$27.53	$42.27	$71.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $10.42 / $17.59	Professional	26	$6.12	$10.42	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.30 / $29.37 / $48.43	Professional	TC	$19.30	$29.37	$48.43
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $37.63 / $49.20 / $67.52	Professional		$37.63	$49.20	$67.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.48 / $11.05 / $67.52	Professional	26	$9.48	$11.05	$67.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $39.75 / $67.52	Professional	TC	$33.11	$39.75	$67.52
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.01 / $214.08 / $408.26	Facility		$39.01	$214.08	$408.26
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 / $50.63	Professional		$29.04	$34.17	$50.63
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.04 / $8.30 / $23.55	Professional	26	$7.04	$8.30	$23.55
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.01 / $26.57 / $42.13	Professional	TC	$22.01	$26.57	$42.13
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 $24.30 / $36.88 / $65.94	Professional		$24.30	$36.88	$65.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.22 / $9.41 / $16.23	Professional	26	$6.22	$9.41	$16.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.01 / $27.80 / $49.74	Professional	TC	$18.01	$27.80	$49.74