Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.31 / $176.20 / $341.42	Facility		$47.31	$176.20	$341.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.83 / $8.84 / $27.87	Facility	26	$8.83	$8.84	$27.87
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.57 / $49.05 / $364.02	Facility	TC	$19.57	$49.05	$364.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.17 / $34.15 / $85.55	Professional		$26.17	$34.15	$85.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $10.33 / $24.92	Professional	26	$8.46	$10.33	$24.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.72 / $23.57 / $36.47	Professional	TC	$17.72	$23.57	$36.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.31 / $21.43 / $33.24	Professional		$15.31	$21.43	$33.24
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.57 / $9.10 / $17.94	Professional	26	$6.57	$9.10	$17.94
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $54.61 / $175.10 / $912.60	Facility		$54.61	$175.10	$912.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $17.00 / $29.90 / $78.00	Professional		$17.00	$29.90	$78.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $15.79 / $31.73	Professional	26	$11.55	$15.79	$31.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $57.52 / $72.28 / $109.14	Facility		$57.52	$72.28	$109.14
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 $17.48 / $17.48 / $17.48	Facility	TC	$17.48	$17.48	$17.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.02 / $43.59 / $70.44	Professional		$26.02	$43.59	$70.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.07 / $12.94 / $21.56	Professional	26	$7.07	$12.94	$21.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.92 / $28.63 / $48.09	Professional	TC	$16.92	$28.63	$48.09
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $38.64 / $45.93 / $62.72	Professional		$38.64	$45.93	$62.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $12.81 / $17.51	Professional	26	$10.96	$12.81	$17.51
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 $215.52 / $258.52 / $458.84	Facility		$215.52	$258.52	$458.84
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $8,702.00 / $8,702.00 / $16,128.00	Facility	TC	$8,702.00	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.98 / $30.74 / $49.11	Professional		$18.98	$30.74	$49.11
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.17 / $9.61 / $27.94	Professional	26	$8.17	$9.61	$27.94
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.27 / $22.34 / $40.75	Professional	TC	$21.27	$22.34	$40.75
United Facility/Professional Professional Modifier Low / Median / High Price $24.90 / $35.49 / $60.83	Professional		$24.90	$35.49	$60.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.45 / $18.93	Professional	26	$7.08	$11.45	$18.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.95 / $24.44 / $41.90	Professional	TC	$17.95	$24.44	$41.90