Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $165.96 / $467.74	Facility		$44.67	$165.96	$467.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $11.22 / $52.48	Facility	26	$6.76	$11.22	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.12 / $60.26 / $154.88	Facility	TC	$25.12	$60.26	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $42.66 / $117.49	Professional		$25.12	$42.66	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.75 / $30.90	Professional	26	$7.08	$11.75	$30.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $26.30 / $66.07	Professional	TC	$16.98	$26.30	$66.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $22.91 / $30.90	Professional		$21.38	$22.91	$30.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $7.94 / $12.02	Professional	26	$6.46	$7.94	$12.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $20.42 / $25.70	Professional	TC	$15.85	$20.42	$25.70
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $416.87 / $2,630.27	Facility		$190.55	$416.87	$2,630.27
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.12 / $12.88 / $37.15	Professional		$9.12	$12.88	$37.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $64.57 / $114.82	Facility		$60.26	$64.57	$114.82
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 $15.49 / $15.49 / $15.49	Facility	TC	$15.49	$15.49	$15.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.90 / $66.07	Professional		$25.12	$38.90	$66.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $10.72 / $17.78	Professional	26	$6.46	$10.72	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $26.30 / $44.67	Professional	TC	$17.38	$26.30	$44.67
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $45.71 / $63.10	Professional		$38.02	$45.71	$63.10
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 $28.84 / $34.67 / $46.77	Professional	TC	$28.84	$34.67	$46.77
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $239.88 / $467.74	Facility		$169.82	$239.88	$467.74
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $9,120.11 / $25,118.86	Facility	TC	$23.99	$9,120.11	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $33.11 / $64.57	Professional		$27.54	$33.11	$64.57
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $8.51 / $18.62	Professional	26	$7.24	$8.51	$18.62
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $24.55 / $44.67	Professional	TC	$19.95	$24.55	$44.67
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $131.83 / $204.17	Facility		$81.28	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $32.36 / $57.54	Professional		$22.91	$32.36	$57.54
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 $16.60 / $23.44 / $42.66	Professional	TC	$16.60	$23.44	$42.66