Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $144.54 / $371.54	Facility		$51.29	$144.54	$371.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $11.75 / $54.95	Facility	26	$7.24	$11.75	$54.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $52.48 / $138.04	Facility	TC	$19.95	$52.48	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $41.69 / $109.65	Professional		$23.99	$41.69	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.00 / $34.67	Professional	26	$7.24	$10.00	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $22.91 / $56.23	Professional	TC	$15.49	$22.91	$56.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $23.44 / $32.36	Professional		$19.05	$23.44	$32.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $8.13 / $16.22	Professional	26	$6.76	$8.13	$16.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $19.05 / $26.30	Professional	TC	$13.80	$19.05	$26.30
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $354.81 / $537.03	Facility		$177.83	$354.81	$537.03
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $19.95 / $58.88	Professional		$9.33	$19.95	$58.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $57.54 / $100.00	Facility		$53.70	$57.54	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $63.10	Professional		$22.91	$37.15	$63.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $11.22 / $18.62	Professional	26	$6.61	$11.22	$18.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $25.12 / $45.71	Professional	TC	$16.22	$25.12	$45.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $42.66 / $57.54	Professional		$35.48	$42.66	$57.54
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $11.75 / $16.22	Professional	26	$10.23	$11.75	$16.22
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $30.20 / $41.69	Professional	TC	$25.12	$30.20	$41.69
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $1,621.81 / $15,848.93	Facility		$141.25	$1,621.81	$15,848.93
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $19.05 / $9,332.54 / $25,703.96	Facility	TC	$19.05	$9,332.54	$25,703.96
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $30.90 / $60.26	Professional		$23.44	$30.90	$60.26
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $8.91 / $19.05	Professional	26	$7.59	$8.91	$19.05
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $23.99 / $38.90	Professional	TC	$18.62	$23.99	$38.90
United Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $131.83 / $204.17	Facility		$117.49	$131.83	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $30.90 / $53.70	Professional		$21.38	$30.90	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.31 / $9.55 / $16.22	Professional	26	$6.31	$9.55	$16.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $20.89 / $37.15	Professional	TC	$14.45	$20.89	$37.15