Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.72 / $181.83 / $508.67	Facility		$57.72	$181.83	$508.67
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 $23.69 / $72.70 / $385.40	Facility	TC	$23.69	$72.70	$385.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.01 / $40.90 / $100.96	Professional		$27.01	$40.90	$100.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $11.15 / $34.20	Professional	26	$8.84	$11.15	$34.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.97 / $50.15	Professional	TC	$19.05	$28.97	$50.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.43 / $33.86 / $43.78	Professional		$22.43	$33.86	$43.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $9.33 / $19.82	Professional	26	$7.24	$9.33	$19.82
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $358.70 / $491.40 / $940.10	Facility		$358.70	$491.40	$940.10
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.73 / $43.24 / $103.00	Professional		$16.73	$43.24	$103.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $17.43 / $33.65	Professional	26	$12.76	$17.43	$33.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $72.34 / $88.65 / $136.19	Facility		$72.34	$88.65	$136.19
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 $17.98 / $17.98 / $17.98	Facility	TC	$17.98	$17.98	$17.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.87 / $49.00 / $80.56	Professional		$30.87	$49.00	$80.56
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 $20.01 / $32.65 / $53.53	Professional	TC	$20.01	$32.65	$53.53
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $45.76 / $55.31 / $95.04	Professional		$45.76	$55.31	$95.04
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $14.15 / $112.53	Professional	26	$12.09	$14.15	$112.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $41.18 / $112.53	Professional	TC	$34.29	$41.18	$112.53
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $215.52 / $258.52 / $493.06	Facility		$215.52	$258.52	$493.06
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $59.32 / $1,165.00 / $16,128.00	Facility	TC	$59.32	$1,165.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $22.61 / $37.21 / $55.71	Professional		$22.61	$37.21	$55.71
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.63 / $34.56	Professional	26	$9.02	$10.63	$34.56
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.75 / $27.94 / $46.92	Professional	TC	$23.75	$27.94	$46.92
United Facility/Professional Facility Modifier Low / Median / High Price $168.12 / $168.12 / $168.12	Facility		$168.12	$168.12	$168.12
United Facility/Professional Professional Modifier Low / Median / High Price $29.65 / $40.85 / $71.06	Professional		$29.65	$40.85	$71.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $12.05 / $20.16	Professional	26	$7.81	$12.05	$20.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.03 / $30.11 / $51.69	Professional	TC	$21.03	$30.11	$51.69