Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.26 / $194.10 / $612.72	Facility		$63.26	$194.10	$612.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $6.84 / $21.15	Facility	26	$6.83	$6.84	$21.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.67 / $68.61 / $547.50	Facility	TC	$18.67	$68.61	$547.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.40 / $35.86 / $105.44	Professional		$11.40	$35.86	$105.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.84 / $8.88 / $36.38	Professional	26	$6.84	$8.88	$36.38
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $27.96 / $51.04 / $329.02	Professional	50	$27.96	$51.04	$329.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $11.21 / $15.91 / $19.22	Professional	52	$11.21	$15.91	$19.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.45 / $24.28 / $44.93	Professional	TC	$17.45	$24.28	$44.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.48 / $28.89 / $34.40	Professional		$18.48	$28.89	$34.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.92 / $7.19 / $15.99	Professional	26	$5.92	$7.19	$15.99
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $27.73 / $27.73 / $85.78	Professional	50	$27.73	$27.73	$85.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.92 / $33.92 / $33.92	Professional	TC	$33.92	$33.92	$33.92
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $44.95 / $261.56 / $1,064.33	Facility		$44.95	$261.56	$1,064.33
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $43.99 / $89.72 / $2,229.05	Facility	TC	$43.99	$89.72	$2,229.05
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $14.09 / $52.41 / $86.97	Professional		$14.09	$52.41	$86.97
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $13.22 / $24.91	Professional	26	$9.31	$13.22	$24.91
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $30.02 / $65.25 / $65.25	Professional	50	$30.02	$65.25	$65.25
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 $13.86 / $13.86 / $13.86	Facility	TC	$13.86	$13.86	$13.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.10 / $40.98 / $68.13	Professional		$26.10	$40.98	$68.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.85 / $10.13 / $17.00	Professional	26	$5.85	$10.13	$17.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $27.22 / $44.64	Professional	TC	$18.14	$27.22	$44.64
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $36.83 / $47.48 / $67.52	Professional		$36.83	$47.48	$67.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.08 / $10.58 / $67.52	Professional	26	$9.08	$10.58	$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 $214.08 / $214.08 / $464.19	Facility		$214.08	$214.08	$464.19
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $47.94 / $8,702.00 / $16,128.00	Facility	TC	$47.94	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.23 / $32.04 / $47.24	Professional		$27.23	$32.04	$47.24
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $7.93 / $31.67	Professional	26	$6.74	$7.93	$31.67
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.49 / $25.06 / $42.25	Professional	TC	$20.49	$25.06	$42.25
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 $23.60 / $34.65 / $59.34	Professional		$23.60	$34.65	$59.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.95 / $9.11 / $15.21	Professional	26	$5.95	$9.11	$15.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.00 / $26.48 / $46.41	Professional	TC	$18.00	$26.48	$46.41