Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $501.19 / $1,202.26	Facility		$74.13	$501.19	$1,202.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $134.90 / $234.42	Facility	26	$33.11	$134.90	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $100.00 / $346.74	Professional		$48.98	$100.00	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $43.65 / $134.90	Professional	26	$25.70	$43.65	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.02 / $194.98	Professional	TC	$20.89	$38.02	$194.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $51.29 / $97.72	Professional		$41.69	$51.29	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $31.62 / $50.12	Professional	26	$23.99	$31.62	$50.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $28.18 / $28.18	Professional	TC	$28.18	$28.18	$28.18
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $269.15 / $1,698.24	Facility		$269.15	$269.15	$1,698.24
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $426.58	Professional		$39.81	$53.70	$426.58
Cigna Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $95.50 / $131.83	Facility		$74.13	$95.50	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $102.33 / $263.03	Professional		$50.12	$102.33	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $39.81 / $67.61	Professional	26	$23.99	$39.81	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $50.12 / $208.93	Professional	TC	$22.91	$50.12	$208.93
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $77.62 / $107.15	Professional		$74.13	$77.62	$107.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $37.15 / $51.29	Professional	26	$35.48	$37.15	$51.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $40.74 / $56.23	Professional	TC	$38.90	$40.74	$56.23
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $1,348.96 / $10,471.29	Facility		$33.11	$1,348.96	$10,471.29
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $57.54 / $158.49	Professional		$46.77	$57.54	$158.49
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $32.36 / $60.26	Professional	26	$25.70	$32.36	$60.26
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $26.92 / $89.13	Professional	TC	$22.91	$26.92	$89.13
United Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $97.72 / $134.90	Facility		$35.48	$97.72	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $93.33 / $194.98	Professional		$50.12	$93.33	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.11 / $57.54	Professional	26	$22.39	$33.11	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $147.91	Professional	TC	$22.91	$33.88	$147.91