Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $14.79 / $72.44	Facility	26	$8.91	$14.79	$72.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $97.72 / $331.13	Facility	TC	$33.88	$97.72	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $53.70 / $165.96	Professional		$16.98	$53.70	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $20.89 / $52.48	Professional	26	$9.55	$20.89	$52.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $44.67 / $114.82 / $257.04	Professional	50	$44.67	$114.82	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $42.66 / $117.49	Professional	TC	$25.70	$42.66	$117.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $39.81 / $58.88	Professional		$30.90	$39.81	$58.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.75 / $22.91	Professional	26	$8.51	$11.75	$22.91
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $67.61 / $114.82	Professional	50	$46.77	$67.61	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $51.29	Professional	TC	$25.70	$38.90	$51.29
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $30.20 / $107.15	Professional		$11.75	$30.20	$107.15
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $8.71 / $8.71 / $28.18	Professional	50	$8.71	$8.71	$28.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $7.24 / $7.24	Facility	26	$7.24	$7.24	$7.24
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.60 / $16.60 / $16.60	Facility	TC	$16.60	$16.60	$16.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.70 / $97.72	Professional		$34.67	$53.70	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.80 / $23.44	Professional	26	$8.51	$13.80	$23.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $66.07	Professional	TC	$23.99	$36.31	$66.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $70.79 / $112.20	Professional		$58.88	$70.79	$112.20
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.14 / $112.20	Professional	26	$12.88	$15.14	$112.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $56.23 / $112.20	Professional	TC	$46.77	$56.23	$112.20
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $33.88 / $8,709.64 / $25,118.86	Facility	TC	$33.88	$8,709.64	$25,118.86
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $43.65 / $83.18	Professional		$30.20	$43.65	$83.18
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.96 / $25.12	Professional	26	$9.33	$10.96	$25.12
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $35.48 / $72.44	Professional	TC	$30.20	$35.48	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $44.67 / $77.62	Professional		$30.90	$44.67	$77.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.75 / $20.42	Professional	26	$7.94	$11.75	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.11 / $61.66	Professional	TC	$22.91	$33.11	$61.66