Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.42 / $5.43 / $17.70	Facility	26	$5.42	$5.43	$17.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.67 / $54.64 / $275.32	Facility	TC	$18.67	$54.64	$275.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.34 / $35.34 / $99.04	Professional		$18.34	$35.34	$99.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.42 / $6.86 / $25.51	Professional	26	$5.42	$6.86	$25.51
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.22 / $48.22 / $48.22	Professional	50	$48.22	$48.22	$48.22
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.06 / $16.30 / $21.33	Professional	52	$12.06	$16.30	$21.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.11 / $26.59 / $51.93	Professional	TC	$19.11	$26.59	$51.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.69 / $28.45 / $39.11	Professional		$17.69	$28.45	$39.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $4.51 / $5.38 / $11.10	Professional	26	$4.51	$5.38	$11.10
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $25.30 / $49.02 / $98.77	Professional		$25.30	$49.02	$98.77
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $7.98 / $10.90 / $19.88	Professional	26	$7.98	$10.90	$19.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.33 / $4.33 / $4.33	Facility	26	$4.33	$4.33	$4.33
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $11.12 / $11.12 / $11.12	Facility	TC	$11.12	$11.12	$11.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.61 / $40.47 / $72.04	Professional		$25.61	$40.47	$72.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $4.91 / $8.36 / $13.79	Professional	26	$4.91	$8.36	$13.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $28.00 / $51.85	Professional	TC	$18.19	$28.00	$51.85
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $36.61 / $49.83 / $67.52	Professional		$36.61	$49.83	$67.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.64 / $8.85 / $67.52	Professional	26	$7.64	$8.85	$67.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.44 / $44.96 / $67.52	Professional	TC	$37.44	$44.96	$67.52
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $8,702.00 / $8,702.00 / $16,128.00	Facility	TC	$8,702.00	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.76 / $35.01 / $48.94	Professional		$29.76	$35.01	$48.94
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $5.64 / $6.65 / $25.10	Professional	26	$5.64	$6.65	$25.10
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.12 / $28.38 / $45.14	Professional	TC	$24.12	$28.38	$45.14
United Facility/Professional Professional Modifier Low / Median / High Price $21.89 / $36.53 / $66.08	Professional		$21.89	$36.53	$66.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.84 / $7.63 / $12.67	Professional	26	$4.84	$7.63	$12.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.85 / $29.35 / $54.85	Professional	TC	$20.85	$29.35	$54.85