Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $173.78 / $616.60	Facility		$64.57	$173.78	$616.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $10.72 / $51.29	Facility	26	$6.76	$10.72	$51.29
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.55 / $70.79 / $257.04	Facility	TC	$24.55	$70.79	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $40.74 / $123.03	Professional		$9.12	$40.74	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.80 / $42.66	Professional	26	$7.08	$13.80	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $79.43 / $204.17	Professional	50	$17.78	$79.43	$204.17
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $32.36 / $32.36 / $61.66	Professional	52	$32.36	$32.36	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $36.31 / $102.33	Professional	TC	$19.95	$36.31	$102.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $29.51 / $44.67	Professional		$21.88	$29.51	$44.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.59 / $13.18	Professional	26	$6.03	$7.59	$13.18
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $32.36 / $40.74 / $64.57	Professional	50	$32.36	$40.74	$64.57
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $24.55 / $34.67	Professional	TC	$18.20	$24.55	$34.67
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $489.78 / $870.96	Facility		$251.19	$489.78	$870.96
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $35.48 / $66.07	Professional		$8.71	$35.48	$66.07
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $30.20 / $58.88 / $64.57	Professional	50	$30.20	$58.88	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $69.18 / $125.89	Facility		$64.57	$69.18	$125.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $5.75 / $5.75	Facility	26	$5.75	$5.75	$5.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $13.80 / $13.80 / $13.80	Facility	TC	$13.80	$13.80	$13.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $40.74 / $70.79	Professional		$26.30	$40.74	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $10.23 / $16.98	Professional	26	$6.17	$10.23	$16.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $27.54 / $47.86	Professional	TC	$18.62	$27.54	$47.86
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $48.98 / $67.61	Professional		$40.74	$48.98	$67.61
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.96 / $67.61	Professional	26	$9.33	$10.96	$67.61
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $38.02 / $67.61	Professional	TC	$31.62	$38.02	$67.61
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $239.88 / $9,772.37	Facility		$38.02	$239.88	$9,772.37
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $8,709.64 / $25,118.86	Facility	TC	$26.30	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $60.26	Professional		$28.18	$33.11	$60.26
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.13 / $17.78	Professional	26	$6.92	$8.13	$17.78
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $25.12 / $53.70	Professional	TC	$21.38	$25.12	$53.70
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $131.83 / $204.17	Facility		$81.28	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $33.88 / $58.88	Professional		$23.44	$33.88	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $8.71 / $15.14	Professional	26	$5.75	$8.71	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $25.12 / $44.67	Professional	TC	$17.38	$25.12	$44.67