Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $258.00 / $4,961.00 / $9,860.00	Facility		$258.00	$4,961.00	$9,860.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.96 / $97.97 / $205.84	Facility	26	$97.96	$97.97	$205.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $258.00 / $398.69 / $671.31	Professional		$258.00	$398.69	$671.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.97 / $132.90 / $211.25	Professional	26	$97.97	$132.90	$211.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $160.03 / $249.37 / $452.27	Professional	TC	$160.03	$249.37	$452.27
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $451.92 / $451.92 / $451.92	Professional		$451.92	$451.92	$451.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $345.84 / $566.72 / $1,118.92	Professional		$345.84	$566.72	$1,118.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.24 / $194.63 / $400.04	Professional	26	$116.24	$194.63	$400.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.24 / $358.30 / $718.88	Professional	TC	$234.24	$358.30	$718.88
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $413.83 / $576.72 / $667.98	Professional		$413.83	$576.72	$667.98
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $140.26 / $190.49 / $227.59	Professional	26	$140.26	$190.49	$227.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $273.57 / $386.24 / $440.41	Professional	TC	$273.57	$386.24	$440.41
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,352.79 / $1,562.90 / $3,518.91	Facility		$1,352.79	$1,562.90	$3,518.91
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $299.75 / $367.49 / $644.20	Professional		$299.75	$367.49	$644.20
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.10 / $120.60 / $212.82	Professional	26	$100.10	$120.60	$212.82
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $212.27 / $249.73 / $439.39	Professional	TC	$212.27	$249.73	$439.39
United Facility/Professional Facility Modifier Low / Median / High Price $2,354.00 / $3,961.00 / $10,536.00	Facility		$2,354.00	$3,961.00	$10,536.00
United Facility/Professional Professional Modifier Low / Median / High Price $264.88 / $395.87 / $889.24	Professional		$264.88	$395.87	$889.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.32 / $131.37 / $284.95	Professional	26	$91.32	$131.37	$284.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.64 / $257.62 / $744.78	Professional	TC	$173.64	$257.62	$744.78