Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $181.97 / $436.52	Facility		$48.98	$181.97	$436.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $11.22 / $57.54	Facility	26	$6.76	$11.22	$57.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.89 / $56.23 / $177.83	Facility	TC	$20.89	$56.23	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $38.02 / $109.65	Professional		$21.88	$38.02	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $9.77 / $30.90	Professional	26	$7.08	$9.77	$30.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $22.39 / $61.66	Professional	TC	$14.79	$22.39	$61.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $26.30 / $40.74	Professional		$18.20	$26.30	$40.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.76 / $14.45	Professional	26	$6.46	$7.76	$14.45
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $16.98 / $24.55	Professional	TC	$16.60	$16.98	$24.55
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $389.05 / $707.95	Facility		$257.04	$389.05	$707.95
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $28.18 / $53.70	Professional		$7.94	$28.18	$53.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $52.48 / $93.33	Facility		$48.98	$52.48	$93.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.75 / $5.75 / $5.75	Facility	26	$5.75	$5.75	$5.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $13.49 / $13.49 / $13.49	Facility	TC	$13.49	$13.49	$13.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $36.31 / $61.66	Professional		$22.39	$36.31	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $18.20	Professional	26	$6.46	$10.72	$18.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.79 / $23.99 / $40.74	Professional	TC	$14.79	$23.99	$40.74
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $39.81 / $54.95	Professional		$33.88	$39.81	$54.95
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $11.48 / $15.49	Professional	26	$9.77	$11.48	$15.49
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $28.84 / $38.90	Professional	TC	$23.99	$28.84	$38.90
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $251.19 / $562.34	Facility		$30.20	$251.19	$562.34
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $20.42 / $9,332.54 / $25,118.86	Facility	TC	$20.42	$9,332.54	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $28.84 / $54.95	Professional		$24.55	$28.84	$54.95
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.51 / $17.78	Professional	26	$7.24	$8.51	$17.78
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $20.42 / $43.65	Professional	TC	$17.38	$20.42	$43.65
United Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $173.78 / $275.42	Facility		$109.65	$173.78	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $29.51 / $56.23	Professional		$20.42	$29.51	$56.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.12 / $15.85	Professional	26	$6.03	$9.12	$15.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $20.42 / $40.74	Professional	TC	$14.13	$20.42	$40.74