Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.35 / $13.36 / $70.37	Facility	26	$13.35	$13.36	$70.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.82 / $65.73 / $245.35	Facility	TC	$26.82	$65.73	$245.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.19 / $45.26 / $78.70	Professional		$35.19	$45.26	$78.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $14.49 / $24.42	Professional	26	$11.40	$14.49	$24.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.90 / $31.62 / $47.57	Professional	TC	$21.90	$31.62	$47.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.69 / $30.69 / $45.05	Professional		$30.69	$30.69	$45.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.68 / $12.72 / $27.95	Professional	26	$10.68	$12.72	$27.95
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $105.00 / $105.00	Professional		$105.00	$105.00	$105.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.26 / $11.26 / $11.26	Facility	26	$11.26	$11.26	$11.26
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $24.11 / $24.11 / $24.11	Facility	TC	$24.11	$24.11	$24.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.09 / $58.86 / $96.33	Professional		$35.09	$58.86	$96.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.86 / $19.22 / $32.72	Professional	26	$9.86	$19.22	$32.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.73 / $39.44 / $65.88	Professional	TC	$23.73	$39.44	$65.88
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $52.25 / $62.16 / $84.56	Professional		$52.25	$62.16	$84.56
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.05 / $17.68 / $23.97	Professional	26	$15.05	$17.68	$23.97
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.04 / $44.49 / $60.59	Professional	TC	$37.04	$44.49	$60.59
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $64.20 / $8,702.00 / $16,128.00	Facility	TC	$64.20	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.61 / $43.07 / $68.34	Professional		$36.61	$43.07	$68.34
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.58 / $13.65 / $44.82	Professional	26	$11.58	$13.65	$44.82
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.02 / $29.44 / $51.31	Professional	TC	$25.02	$29.44	$51.31
United Facility/Professional Professional Modifier Low / Median / High Price $34.81 / $50.45 / $85.83	Professional		$34.81	$50.45	$85.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $16.30 / $28.52	Professional	26	$9.93	$16.30	$28.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.15 / $33.84 / $57.41	Professional	TC	$24.15	$33.84	$57.41