Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.73 / $166.54 / $381.84	Facility		$53.73	$166.54	$381.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.83 / $8.84 / $29.55	Facility	26	$8.83	$8.84	$29.55
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.10 / $60.86 / $251.32	Facility	TC	$22.10	$60.86	$251.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.49 / $39.89 / $98.79	Professional		$26.49	$39.89	$98.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.61 / $11.14 / $24.89	Professional	26	$8.61	$11.14	$24.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $28.26 / $50.15	Professional	TC	$18.82	$28.26	$50.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.38 / $31.22 / $43.78	Professional		$18.38	$31.22	$43.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $9.40 / $17.57	Professional	26	$7.88	$9.40	$17.57
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $245.65 / $357.85 / $885.50	Facility		$245.65	$357.85	$885.50
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $19.28 / $50.51 / $103.00	Professional		$19.28	$50.51	$103.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $71.52 / $87.64 / $136.07	Facility		$71.52	$87.64	$136.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.17 / $7.17 / $7.17	Facility	26	$7.17	$7.17	$7.17
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.23 / $16.23 / $16.23	Facility	TC	$16.23	$16.23	$16.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.95 / $47.18 / $81.97	Professional		$29.95	$47.18	$81.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $13.60 / $22.78	Professional	26	$7.78	$13.60	$22.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.60 / $30.44 / $52.01	Professional	TC	$19.60	$30.44	$52.01
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $44.89 / $55.31 / $75.39	Professional		$44.89	$55.31	$75.39
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $14.15 / $19.29	Professional	26	$12.09	$14.15	$19.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $41.18 / $56.10	Professional	TC	$34.29	$41.18	$56.10
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $193.71 / $214.08 / $7,628.00	Facility		$193.71	$214.08	$7,628.00
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $55.26 / $8,702.00 / $16,128.00	Facility	TC	$55.26	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.61 / $37.21 / $52.24	Professional		$22.61	$37.21	$52.24
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.61 / $32.72	Professional	26	$9.02	$10.61	$32.72
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.75 / $27.94 / $42.30	Professional	TC	$23.75	$27.94	$42.30
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 $28.23 / $42.27 / $69.72	Professional		$28.23	$42.27	$69.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $12.05 / $20.16	Professional	26	$7.92	$12.05	$20.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $29.77 / $51.43	Professional	TC	$19.89	$29.77	$51.43