Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $127.21 / $4,134.00 / $9,842.00	Facility		$127.21	$4,134.00	$9,842.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.20 / $36.20 / $63.99	Facility	26	$36.20	$36.20	$63.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.37 / $158.74 / $249.23	Professional		$122.37	$158.74	$249.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.20 / $42.52 / $70.16	Professional	26	$36.20	$42.52	$70.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.84 / $108.87 / $199.32	Professional	TC	$79.84	$108.87	$199.32
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $162.90 / $162.90 / $217.20	Professional		$162.90	$162.90	$217.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.82 / $228.55 / $481.40	Professional		$146.82	$228.55	$481.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.82 / $64.98 / $131.35	Professional	26	$36.82	$64.98	$131.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.43 / $169.38 / $377.45	Professional	TC	$101.43	$169.38	$377.45
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $37.50 / $251.53 / $309.72	Professional		$37.50	$251.53	$309.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.53 / $59.80 / $71.17	Professional	26	$43.53	$59.80	$71.17
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.88 / $209.44 / $238.53	Professional	TC	$147.88	$209.44	$238.53
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.53 / $153.43 / $283.76	Professional		$104.53	$153.43	$283.76
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.98 / $37.29 / $177.37	Professional	26	$30.98	$37.29	$177.37
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $99.43 / $148.16 / $270.11	Professional	TC	$99.43	$148.16	$270.11
United Facility/Professional Facility Modifier Low / Median / High Price $1,529.00 / $3,352.00 / $10,536.00	Facility		$1,529.00	$3,352.00	$10,536.00
United Facility/Professional Professional Modifier Low / Median / High Price $122.50 / $189.80 / $387.82	Professional		$122.50	$189.80	$387.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.71 / $44.73 / $94.35	Professional	26	$28.71	$44.73	$94.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.61 / $144.44 / $281.36	Professional	TC	$85.61	$144.44	$281.36