Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $165.96 / $416.87	Facility		$42.66	$165.96	$416.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $11.75 / $54.95	Facility	26	$7.24	$11.75	$54.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $11.75 / $37.15 / $177.83	Facility	TC	$11.75	$37.15	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $28.84 / $83.18	Professional		$16.98	$28.84	$83.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $9.55 / $33.88	Professional	26	$7.41	$9.55	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $15.85 / $35.48	Professional	TC	$10.00	$15.85	$35.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $19.50 / $26.30	Professional		$16.98	$19.50	$26.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.94 / $15.14	Professional	26	$6.46	$7.94	$15.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $18.62 / $21.88	Professional	TC	$12.30	$18.62	$21.88
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $316.23 / $389.05	Facility		$154.88	$316.23	$389.05
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $15.49 / $45.71	Professional		$9.12	$15.49	$45.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $45.71 / $81.28	Facility		$42.66	$45.71	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $28.84 / $51.29	Professional		$18.62	$28.84	$51.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $11.22 / $18.62	Professional	26	$6.61	$11.22	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $16.22 / $30.90	Professional	TC	$10.72	$16.22	$30.90
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $36.31 / $48.98	Professional		$30.20	$36.31	$48.98
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $11.22 / $15.49	Professional	26	$9.77	$11.22	$15.49
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $24.55 / $33.88	Professional	TC	$20.42	$24.55	$33.88
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $245.47 / $467.74	Facility		$93.33	$245.47	$467.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $12.59 / $10,471.29 / $25,118.86	Facility	TC	$12.59	$10,471.29	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $25.70 / $47.86	Professional		$21.38	$25.70	$47.86
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $8.91 / $16.22	Professional	26	$7.59	$8.91	$16.22
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $16.98 / $28.84	Professional	TC	$14.45	$16.98	$28.84
United Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $131.83 / $204.17	Facility		$117.49	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $25.70 / $44.67	Professional		$16.60	$25.70	$44.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $9.55 / $16.22	Professional	26	$6.17	$9.55	$16.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $16.60 / $28.84	Professional	TC	$9.77	$16.60	$28.84