Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $144.54 / $398.11	Facility		$57.54	$144.54	$398.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $13.80 / $64.57	Facility	26	$8.51	$13.80	$64.57
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $60.26 / $204.17	Facility	TC	$23.44	$60.26	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $41.69 / $125.89	Professional		$25.12	$41.69	$125.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.49 / $43.65	Professional	26	$8.91	$13.49	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $27.54 / $69.18	Professional	TC	$16.98	$27.54	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $26.92 / $38.02	Professional		$21.88	$26.92	$38.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $9.77 / $17.38	Professional	26	$7.76	$9.77	$17.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $19.95 / $29.51	Professional	TC	$14.13	$19.95	$29.51
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $363.08 / $776.25	Facility		$239.88	$363.08	$776.25
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $32.36 / $66.07	Professional		$11.22	$32.36	$66.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $61.66 / $109.65	Facility		$57.54	$61.66	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $40.74 / $70.79	Professional		$25.12	$40.74	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.49 / $21.88	Professional	26	$7.94	$13.49	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $27.54 / $50.12	Professional	TC	$17.78	$27.54	$50.12
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $89.13	Professional		$39.81	$46.77	$89.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $13.49 / $89.13	Professional	26	$11.75	$13.49	$89.13
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $33.11 / $89.13	Professional	TC	$27.54	$33.11	$89.13
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $218.78 / $467.74	Facility		$35.48	$218.78	$467.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $9,332.54 / $25,118.86	Facility	TC	$23.44	$9,332.54	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $63.10	Professional		$28.18	$33.11	$63.10
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $10.47 / $22.91	Professional	26	$8.91	$10.47	$22.91
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $22.91 / $44.67	Professional	TC	$19.50	$22.91	$44.67
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 $23.99 / $34.67 / $58.88	Professional		$23.99	$34.67	$58.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.48 / $19.95	Professional	26	$7.41	$11.48	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $22.91 / $39.81	Professional	TC	$15.85	$22.91	$39.81