Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $61.66 / $162.18	Professional		$46.77	$61.66	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $32.36 / $141.25	Professional	26	$19.05	$32.36	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.02 / $107.15	Professional	TC	$26.92	$38.02	$107.15
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $97.72 / $245.47	Professional		$40.74	$97.72	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $64.57 / $173.78	Professional		$37.15	$64.57	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $30.90 / $89.13	Professional	26	$15.14	$30.90	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $38.02 / $85.11	Professional	TC	$21.38	$38.02	$85.11
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $79.43 / $107.15	Professional		$50.12	$79.43	$107.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $30.20 / $102.33	Professional	26	$19.50	$30.20	$102.33
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $48.98 / $75.86	Professional	TC	$30.20	$48.98	$75.86
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $13,803.84 / $16,218.10 / $19,498.45	Facility		$13,803.84	$16,218.10	$19,498.45
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $63.10 / $162.18	Professional		$46.77	$63.10	$162.18
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $31.62 / $100.00	Professional	26	$18.62	$31.62	$100.00
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $43.65 / $89.13	Professional	TC	$28.18	$43.65	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $58.88 / $104.71	Professional		$33.11	$58.88	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $26.92 / $45.71	Professional	26	$12.88	$26.92	$45.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $58.88	Professional	TC	$19.95	$32.36	$58.88