Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.70 / $188.04 / $626.17	Facility		$79.70	$188.04	$626.17
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.88 / $11.17 / $63.17	Facility	26	$8.88	$11.17	$63.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.46 / $77.54 / $337.82	Facility	TC	$25.46	$77.54	$337.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.83 / $43.23 / $107.48	Professional		$11.83	$43.23	$107.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $11.03 / $30.24	Professional	26	$8.46	$11.03	$30.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.81 / $31.29 / $59.65	Professional	TC	$23.81	$31.29	$59.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.38 / $37.34 / $56.02	Professional		$26.38	$37.34	$56.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $10.03 / $19.80	Professional	26	$7.88	$10.03	$19.80
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $49.60 / $202.27 / $3,955.50	Facility		$49.60	$202.27	$3,955.50
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $15.60 / $31.50 / $110.70	Professional		$15.60	$31.50	$110.70
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $10.98 / $15.75 / $23.55	Professional	26	$10.98	$15.75	$23.55
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.27 / $111.78 / $155.15	Facility		$91.27	$111.78	$155.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.27 / $55.26 / $92.73	Professional		$34.27	$55.26	$92.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.72 / $13.62 / $22.61	Professional	26	$7.72	$13.62	$22.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.39 / $41.94 / $66.04	Professional	TC	$26.39	$41.94	$66.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $51.19 / $66.69 / $90.77	Professional		$51.19	$66.69	$90.77
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $14.15 / $19.29	Professional	26	$12.09	$14.15	$19.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.74 / $52.54 / $71.48	Professional	TC	$43.74	$52.54	$71.48
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $45.10 / $214.08 / $243.38	Facility		$45.10	$214.08	$243.38
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $56.38 / $8,702.00 / $16,128.00	Facility	TC	$56.38	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.67 / $44.32 / $63.92	Professional		$37.67	$44.32	$63.92
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $10.88 / $43.61	Professional	26	$9.02	$10.88	$43.61
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.65 / $33.70 / $53.04	Professional	TC	$28.65	$33.70	$53.04
United Facility/Professional Professional Modifier Low / Median / High Price $32.97 / $48.18 / $83.80	Professional		$32.97	$48.18	$83.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.81 / $12.45 / $20.16	Professional	26	$7.81	$12.45	$20.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.27 / $37.76 / $64.06	Professional	TC	$25.27	$37.76	$64.06