Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.80 / $159.00 / $627.52	Facility		$53.80	$159.00	$627.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.42 / $10.15 / $25.23	Facility	26	$7.42	$10.15	$25.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $17.67 / $51.68 / $294.88	Facility	TC	$17.67	$51.68	$294.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.45 / $34.40 / $91.97	Professional		$11.45	$34.40	$91.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.42 / $9.73 / $30.86	Professional	26	$7.42	$9.73	$30.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $19.27 / $62.52 / $180.26	Professional	50	$19.27	$62.52	$180.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.63 / $22.37 / $47.04	Professional	TC	$16.63	$22.37	$47.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.68 / $31.16 / $35.06	Professional		$20.68	$31.16	$35.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.10 / $7.92 / $16.73	Professional	26	$6.10	$7.92	$16.73
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $27.87 / $46.75 / $46.75	Professional	50	$27.87	$46.75	$46.75
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $47.02 / $261.56 / $1,070.94	Facility		$47.02	$261.56	$1,070.94
AmeriHealth Facility/Professional Facility Modifier TC Low / Median / High Price $498.04 / $1,037.34 / $1,220.07	Facility	TC	$498.04	$1,037.34	$1,220.07
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $16.02 / $42.77 / $91.50	Professional		$16.02	$42.77	$91.50
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $9.56 / $13.38 / $30.19	Professional	26	$9.56	$13.38	$30.19
AmeriHealth Facility/Professional Professional Modifier 50 Low / Median / High Price $74.09 / $74.09 / $74.09	Professional	50	$74.09	$74.09	$74.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.11 / $78.59 / $120.53	Facility		$64.11	$78.59	$120.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.99 / $5.99 / $5.99	Facility	26	$5.99	$5.99	$5.99
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $15.49 / $15.49 / $15.49	Facility	TC	$15.49	$15.49	$15.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.10 / $40.92 / $67.94	Professional		$26.10	$40.92	$67.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.60 / $11.49 / $19.46	Professional	26	$6.60	$11.49	$19.46
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.29 / $27.30 / $43.64	Professional	TC	$17.29	$27.30	$43.64
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $35.94 / $48.39 / $78.76	Professional		$35.94	$48.39	$78.76
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.24 / $11.95 / $78.76	Professional	26	$10.24	$11.95	$78.76
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.36 / $36.44 / $78.76	Professional	TC	$30.36	$36.44	$78.76
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.45 / $178.45 / $379.92	Facility		$34.45	$178.45	$379.92
Horizon BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $43.06 / $8,702.00 / $16,128.00	Facility	TC	$43.06	$8,702.00	$16,128.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.51 / $33.77 / $51.47	Professional		$27.51	$33.77	$51.47
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.62 / $9.19 / $28.70	Professional	26	$7.62	$9.19	$28.70
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $23.40 / $35.10	Professional	TC	$19.89	$23.40	$35.10
United Facility/Professional Professional Modifier Low / Median / High Price $23.81 / $35.61 / $59.09	Professional		$23.81	$35.61	$59.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.72 / $10.31 / $17.03	Professional	26	$6.72	$10.31	$17.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.39 / $25.75 / $43.79	Professional	TC	$17.39	$25.75	$43.79