Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.24 / $169.66 / $181.54	Facility		$87.24	$169.66	$181.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.35 / $61.88 / $61.88	Facility	26	$46.35	$61.88	$61.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.28 / $102.71 / $243.86	Professional		$60.28	$102.71	$243.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $57.40 / $91.96	Professional	26	$34.40	$57.40	$91.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.98 / $47.83 / $154.18	Professional	TC	$25.98	$47.83	$154.18
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $61.23 / $69.84 / $588.28	Professional		$61.23	$69.84	$588.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $219.17 / $219.17 / $229.90	Facility		$219.17	$219.17	$229.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.08 / $81.08 / $81.08	Facility	26	$81.08	$81.08	$81.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.07 / $191.26 / $430.09	Professional		$63.07	$191.26	$430.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.57 / $81.09 / $170.34	Professional	26	$34.57	$81.09	$170.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.23 / $103.93 / $270.27	Professional	TC	$28.23	$103.93	$270.27
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $74.62 / $98.65 / $126.05	Professional		$74.62	$98.65	$126.05
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.59 / $54.72 / $69.91	Professional	26	$41.59	$54.72	$69.91
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $43.94 / $56.14	Professional	TC	$33.03	$43.94	$56.14
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $306.98 / $380.40 / $772.53	Facility		$306.98	$380.40	$772.53
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $34.34 / $54.85 / $223.58	Professional		$34.34	$54.85	$223.58
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.38 / $35.36 / $64.53	Professional	26	$29.38	$35.36	$64.53
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.59 / $29.16 / $85.25	Professional	TC	$23.59	$29.16	$85.25
United Facility/Professional Facility Modifier Low / Median / High Price $1,516.00 / $3,336.00 / $9,152.00	Facility		$1,516.00	$3,336.00	$9,152.00
United Facility/Professional Professional Modifier Low / Median / High Price $56.32 / $115.07 / $222.00	Professional		$56.32	$115.07	$222.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.24 / $49.95 / $93.30	Professional	26	$31.24	$49.95	$93.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.38 / $41.79 / $121.62	Professional	TC	$23.38	$41.79	$121.62