Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.17 / $151.41 / $425.95	Facility		$48.17	$151.41	$425.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.58 / $9.44 / $44.48	Facility	26	$8.58	$9.44	$44.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.69 / $61.57 / $295.68	Facility	TC	$16.69	$61.57	$295.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.68 / $34.79 / $81.20	Professional		$24.68	$34.79	$81.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.35 / $10.82 / $36.04	Professional	26	$8.35	$10.82	$36.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.69 / $20.60 / $37.08	Professional	TC	$15.69	$20.60	$37.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.66 / $29.13 / $31.82	Professional		$19.66	$29.13	$31.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $9.74 / $19.14	Professional	26	$7.66	$9.74	$19.14
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $17.57 / $32.04	Professional	TC	$17.57	$17.57	$32.04
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $240.65 / $364.98 / $810.60	Facility		$240.65	$364.98	$810.60
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $996.21 / $996.21 / $996.21	Facility	TC	$996.21	$996.21	$996.21
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $14.95 / $41.66 / $81.75	Professional		$14.95	$41.66	$81.75
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $17.86 / $30.95	Professional	26	$12.03	$17.86	$30.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $57.52 / $70.54 / $109.48	Facility		$57.52	$70.54	$109.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.33 / $39.95 / $67.50	Professional		$24.33	$39.95	$67.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $13.14 / $21.88	Professional	26	$7.46	$13.14	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.92 / $26.91 / $43.21	Professional	TC	$16.92	$26.91	$43.21
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $37.60 / $46.79 / $63.86	Professional		$37.60	$46.79	$63.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $13.68 / $18.64	Professional	26	$11.69	$13.68	$18.64
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.61 / $33.11 / $45.21	Professional	TC	$27.61	$33.11	$45.21
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $214.08 / $214.08 / $408.26	Facility		$214.08	$214.08	$408.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $44.34 / $8,702.00 / $16,128.00	Facility	TC	$44.34	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.31 / $31.88 / $47.80	Professional		$24.31	$31.88	$47.80
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.72 / $10.27 / $28.83	Professional	26	$8.72	$10.27	$28.83
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.38 / $21.62 / $34.38	Professional	TC	$18.38	$21.62	$34.38
United Facility/Professional Professional Modifier Low / Median / High Price $24.37 / $35.97 / $58.13	Professional		$24.37	$35.97	$58.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.47 / $11.84 / $20.09	Professional	26	$7.47	$11.84	$20.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.63 / $23.82 / $41.79	Professional	TC	$15.63	$23.82	$41.79