Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $43.00 / $143.40 / $329.51	Facility		$43.00	$143.40	$329.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.20 / $7.21 / $22.95	Facility	26	$7.20	$7.21	$22.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $15.47 / $37.59 / $189.34	Facility	TC	$15.47	$37.59	$189.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.95 / $28.94 / $79.20	Professional		$21.95	$28.94	$79.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.20 / $8.98 / $24.70	Professional	26	$7.20	$8.98	$24.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.55 / $18.48 / $35.09	Professional	TC	$14.55	$18.48	$35.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $13.91 / $22.56 / $30.20	Professional		$13.91	$22.56	$30.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.40 / $8.08 / $16.12	Professional	26	$6.40	$8.08	$16.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.67 / $27.67 / $27.67	Professional	TC	$27.67	$27.67	$27.67
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $50.06 / $181.85 / $1,202.04	Facility		$50.06	$181.85	$1,202.04
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $11.82 / $20.00 / $56.46	Professional		$11.82	$20.00	$56.46
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $10.34 / $15.14 / $23.12	Professional	26	$10.34	$15.14	$23.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.41 / $65.51 / $100.18	Facility		$53.41	$65.51	$100.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $21.86 / $35.88 / $58.47	Professional		$21.86	$35.88	$58.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.28 / $11.03 / $18.41	Professional	26	$6.28	$11.03	$18.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.68 / $24.96 / $40.06	Professional	TC	$15.68	$24.96	$40.06
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $41.75 / $57.11	Professional		$33.72	$41.75	$57.11
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.85 / $11.48 / $15.74	Professional	26	$9.85	$11.48	$15.74
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.25 / $30.28 / $41.37	Professional	TC	$25.25	$30.28	$41.37
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $178.45 / $214.08 / $2,360.00	Facility		$178.45	$214.08	$2,360.00
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $34.94 / $8,702.00 / $16,128.00	Facility	TC	$34.94	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $17.72 / $25.22 / $42.68	Professional		$17.72	$25.22	$42.68
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.31 / $8.60 / $15.21	Professional	26	$7.31	$8.60	$15.21
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.72 / $24.27 / $33.19	Professional	TC	$17.72	$24.27	$33.19
United Facility/Professional Professional Modifier Low / Median / High Price $21.74 / $32.29 / $51.91	Professional		$21.74	$32.29	$51.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.27 / $10.06 / $16.86	Professional	26	$6.27	$10.06	$16.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.88 / $21.88 / $38.40	Professional	TC	$14.88	$21.88	$38.40