Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.69 / $181.83 / $463.37	Facility		$43.69	$181.83	$463.37
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.83 / $6.84 / $22.10	Facility	26	$6.83	$6.84	$22.10
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $17.98 / $43.69 / $211.83	Facility	TC	$17.98	$43.69	$211.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.85 / $31.53 / $87.56	Professional		$21.85	$31.53	$87.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.64 / $8.13 / $17.98	Professional	26	$6.64	$8.13	$17.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.75 / $21.70 / $41.05	Professional	TC	$15.75	$21.70	$41.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $15.13 / $22.48 / $33.02	Professional		$15.13	$22.48	$33.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.18 / $7.51 / $17.16	Professional	26	$6.18	$7.51	$17.16
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $48.54 / $113.31 / $2,630.75	Facility		$48.54	$113.31	$2,630.75
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.11 / $13.00 / $36.74	Professional		$9.11	$13.00	$36.74
Cigna Facility/Professional Facility Modifier Low / Median / High Price $59.99 / $74.94 / $114.14	Facility		$59.99	$74.94	$114.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.76 / $5.76 / $5.76	Facility	26	$5.76	$5.76	$5.76
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $15.49 / $15.49 / $15.49	Facility	TC	$15.49	$15.49	$15.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.89 / $39.38 / $64.28	Professional		$24.89	$39.38	$64.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.12 / $10.39 / $17.59	Professional	26	$6.12	$10.39	$17.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.39 / $26.97 / $42.81	Professional	TC	$16.39	$26.97	$42.81
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $35.36 / $45.59 / $62.30	Professional		$35.36	$45.59	$62.30
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.48 / $11.05 / $15.16	Professional	26	$9.48	$11.05	$15.16
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.79 / $34.54 / $47.14	Professional	TC	$28.79	$34.54	$47.14
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $172.75 / $214.08 / $379.92	Facility		$172.75	$214.08	$379.92
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $43.88 / $8,702.00 / $16,128.00	Facility	TC	$43.88	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.03 / $31.96 / $51.85	Professional		$26.03	$31.96	$51.85
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.04 / $8.27 / $14.66	Professional	26	$7.04	$8.27	$14.66
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $23.46 / $36.93	Professional	TC	$18.98	$23.46	$36.93
United Facility/Professional Facility Modifier Low / Median / High Price $119.72 / $119.72 / $119.72	Facility		$119.72	$119.72	$119.72
United Facility/Professional Professional Modifier Low / Median / High Price $23.67 / $33.14 / $58.07	Professional		$23.67	$33.14	$58.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.10 / $9.13 / $15.81	Professional	26	$6.10	$9.13	$15.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.39 / $24.59 / $43.20	Professional	TC	$17.39	$24.59	$43.20