Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.15 / $11.15 / $57.65	Facility	26	$11.15	$11.15	$57.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.26 / $51.66 / $252.22	Facility	TC	$21.26	$51.66	$252.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.55 / $38.24 / $61.25	Professional		$30.55	$38.24	$61.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.61 / $12.67 / $18.47	Professional	26	$10.61	$12.67	$18.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.94 / $25.06 / $34.99	Professional	TC	$19.94	$25.06	$34.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $27.29 / $27.29 / $27.29	Professional		$27.29	$27.29	$27.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.40 / $11.44 / $11.44	Professional	26	$10.40	$11.44	$11.44
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $84.50 / $84.50 / $115.20	Professional		$84.50	$84.50	$115.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.53 / $51.15 / $83.46	Professional		$30.53	$51.15	$83.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.60 / $16.64 / $27.76	Professional	26	$9.60	$16.64	$27.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.56 / $34.17 / $55.02	Professional	TC	$21.56	$34.17	$55.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $47.46 / $58.41 / $79.51	Professional		$47.46	$58.41	$79.51
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $17.25 / $23.41	Professional	26	$14.69	$17.25	$23.41
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $41.18 / $56.10	Professional	TC	$34.29	$41.18	$56.10
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $56.46 / $8,702.00 / $16,128.00	Facility	TC	$56.46	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.31 / $40.25 / $59.62	Professional		$27.31	$40.25	$59.62
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.00 / $13.27 / $34.21	Professional	26	$11.00	$13.27	$34.21
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.21 / $28.69 / $47.44	Professional	TC	$23.21	$28.69	$47.44
United Facility/Professional Professional Modifier Low / Median / High Price $30.70 / $45.29 / $74.81	Professional		$30.70	$45.29	$74.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.52 / $14.88 / $24.58	Professional	26	$9.52	$14.88	$24.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $30.53 / $51.69	Professional	TC	$19.89	$30.53	$51.69