Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $162.18 / $478.63	Facility		$54.95	$162.18	$478.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $10.72 / $52.48	Facility	26	$6.76	$10.72	$52.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $60.26 / $158.49	Facility	TC	$22.91	$60.26	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $33.11 / $100.00	Professional		$10.96	$33.11	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $11.22 / $34.67	Professional	26	$7.08	$11.22	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.70 / $64.57	Professional	TC	$16.98	$25.70	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $25.12 / $44.67	Professional		$19.50	$25.12	$44.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.59 / $15.49	Professional	26	$6.03	$7.59	$15.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $22.91 / $30.20	Professional	TC	$18.62	$22.91	$30.20
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $407.38 / $426.58	Facility		$288.40	$407.38	$426.58
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $29.51 / $323.59	Professional		$8.32	$29.51	$323.59
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 $24.55 / $38.90 / $64.57	Professional		$24.55	$38.90	$64.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.23 / $16.60	Professional	26	$6.03	$10.23	$16.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $26.30 / $43.65	Professional	TC	$16.60	$26.30	$43.65
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 $9.33 / $10.96 / $15.14	Professional	26	$9.33	$10.96	$15.14
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $34.67 / $47.86	Professional	TC	$28.84	$34.67	$47.86
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $218.78 / $9,772.37	Facility		$34.67	$218.78	$9,772.37
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $23.44 / $8,709.64 / $25,118.86	Facility	TC	$23.44	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $32.36 / $61.66	Professional		$26.92	$32.36	$61.66
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $8.13 / $18.62	Professional	26	$6.92	$8.13	$18.62
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $23.99 / $46.77	Professional	TC	$20.42	$23.99	$46.77
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 $22.39 / $32.36 / $57.54	Professional		$22.39	$32.36	$57.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.75 / $8.71 / $15.14	Professional	26	$5.75	$8.71	$15.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $23.44 / $42.66	Professional	TC	$16.60	$23.44	$42.66