Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $66.07 / $97.72	Facility	26	$19.05	$66.07	$97.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $53.70 / $85.11 / $199.53	Facility	TC	$53.70	$85.11	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $47.86 / $134.90	Professional		$33.88	$47.86	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.22 / $36.31	Professional	26	$12.02	$16.22	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.84 / $58.88	Professional	TC	$20.89	$28.84	$58.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $29.51 / $29.51	Professional		$29.51	$29.51	$29.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $28.18 / $30.20	Professional	TC	$28.18	$28.18	$30.20
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Professional		$53.70	$53.70	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $56.23 / $95.50	Professional		$34.67	$56.23	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $19.50 / $31.62	Professional	26	$11.48	$19.50	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $36.31 / $64.57	Professional	TC	$23.44	$36.31	$64.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $64.57 / $87.10	Professional		$53.70	$64.57	$87.10
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $19.95 / $27.54	Professional	26	$17.38	$19.95	$27.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $43.65 / $60.26	Professional	TC	$36.31	$43.65	$60.26
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $10,471.29 / $25,703.96	Facility	TC	$30.20	$10,471.29	$25,703.96
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $45.71 / $87.10	Professional		$38.90	$45.71	$87.10
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $15.85 / $33.88	Professional	26	$13.49	$15.85	$33.88
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $29.51 / $57.54	Professional	TC	$25.12	$29.51	$57.54
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $47.86 / $81.28	Professional		$33.11	$47.86	$81.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $28.84	Professional	26	$10.96	$16.98	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $52.48	Professional	TC	$20.89	$30.20	$52.48