Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $57.54 / $102.33	Facility	26	$13.49	$57.54	$102.33
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.15 / $85.11 / $213.80	Facility	TC	$37.15	$85.11	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $51.29 / $141.25	Professional		$36.31	$51.29	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.95 / $60.26	Professional	26	$10.96	$19.95	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $79.43	Professional	TC	$21.88	$32.36	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $32.36 / $81.28	Professional		$28.84	$32.36	$81.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.30 / $19.05	Professional	26	$10.47	$12.30	$19.05
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Professional		$104.71	$104.71	$104.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.22 / $11.22 / $11.22	Facility	26	$11.22	$11.22	$11.22
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $23.99 / $23.99	Facility	TC	$23.99	$23.99	$23.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $57.54 / $95.50	Professional		$35.48	$57.54	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $19.50 / $31.62	Professional	26	$10.72	$19.50	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.02 / $64.57	Professional	TC	$23.99	$38.02	$64.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $61.66 / $85.11	Professional		$52.48	$61.66	$85.11
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $17.78 / $23.99	Professional	26	$15.14	$17.78	$23.99
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $44.67 / $60.26	Professional	TC	$37.15	$44.67	$60.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $34.67 / $9,332.54 / $25,703.96	Facility	TC	$34.67	$9,332.54	$25,703.96
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $44.67 / $93.33	Professional		$38.02	$44.67	$93.33
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.13 / $33.11	Professional	26	$11.75	$14.13	$33.11
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $30.90 / $66.07	Professional	TC	$26.30	$30.90	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $85.11	Professional		$32.36	$48.98	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $16.22 / $28.18	Professional	26	$9.55	$16.22	$28.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.11 / $57.54	Professional	TC	$22.91	$33.11	$57.54