Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.18 / $164.20 / $397.82	Facility		$38.18	$164.20	$397.82
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.20 / $7.93 / $37.32	Facility	26	$7.20	$7.93	$37.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $9.07 / $44.43 / $289.54	Facility	TC	$9.07	$44.43	$289.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.29 / $21.46 / $49.42	Professional		$16.29	$21.46	$49.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.21 / $9.06 / $24.60	Professional	26	$7.21	$9.06	$24.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.07 / $11.75 / $19.92	Professional	TC	$9.07	$11.75	$19.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.94 / $20.63 / $26.02	Professional		$17.94	$20.63	$26.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.40 / $7.81 / $15.07	Professional	26	$6.40	$7.81	$15.07
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $153.90 / $319.06 / $393.55	Facility		$153.90	$319.06	$393.55
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $51.57 / $114.90 / $1,148.00	Facility	TC	$51.57	$114.90	$1,148.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.46 / $15.76 / $68.25	Professional		$9.46	$15.76	$68.25
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $10.10 / $15.14 / $26.01	Professional	26	$10.10	$15.14	$26.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $42.71 / $52.43 / $80.94	Facility		$42.71	$52.43	$80.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $17.89 / $27.32 / $48.76	Professional		$17.89	$27.32	$48.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.28 / $11.01 / $18.00	Professional	26	$6.28	$11.01	$18.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.53 / $15.23 / $27.56	Professional	TC	$10.53	$15.23	$27.56
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $24.21 / $33.61 / $49.42	Professional		$24.21	$33.61	$49.42
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.85 / $11.48 / $15.74	Professional	26	$9.85	$11.48	$15.74
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $24.59 / $33.68	Professional	TC	$20.53	$24.59	$33.68
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $206.18 / $214.08 / $379.92	Facility		$206.18	$214.08	$379.92
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $8,702.00 / $15,719.00 / $16,128.00	Facility	TC	$8,702.00	$15,719.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $14.88 / $23.11 / $36.88	Professional		$14.88	$23.11	$36.88
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.31 / $8.60 / $15.18	Professional	26	$7.31	$8.60	$15.18
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.54 / $17.11 / $28.26	Professional	TC	$14.54	$17.11	$28.26
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 $16.93 / $26.13 / $45.89	Professional		$16.93	$26.13	$45.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.18 / $17.12	Professional	26	$6.46	$10.18	$17.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.80 / $16.94 / $30.52	Professional	TC	$10.80	$16.94	$30.52