Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.56 / $275.33 / $593.48	Facility		$77.56	$275.33	$593.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.73 / $13.73 / $65.92	Facility	26	$13.73	$13.73	$65.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.48 / $91.36 / $144.80	Professional		$66.48	$91.36	$144.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.48 / $14.97 / $23.96	Professional	26	$12.48	$14.97	$23.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.34 / $76.31 / $105.33	Professional	TC	$56.34	$76.31	$105.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.67 / $14.64 / $31.37	Professional	26	$12.67	$14.64	$31.37
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $27.01 / $27.01 / $27.01	Professional		$27.01	$27.01	$27.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $218.87 / $275.02 / $441.35	Facility		$218.87	$275.02	$441.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.03 / $11.03 / $11.03	Facility	26	$11.03	$11.03	$11.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.56 / $113.36 / $191.62	Professional		$74.56	$113.36	$191.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $19.47 / $32.34	Professional	26	$10.97	$19.47	$32.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.37 / $91.95 / $160.60	Professional	TC	$60.37	$91.95	$160.60
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $104.62 / $142.50 / $193.08	Professional		$104.62	$142.50	$193.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.25 / $20.30 / $27.46	Professional	26	$17.25	$20.30	$27.46
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.59 / $122.20 / $165.61	Professional	TC	$101.59	$122.20	$165.61
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $538.58 / $587.66 / $1,120.74	Facility		$538.58	$587.66	$1,120.74
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.78 / $99.56 / $149.68	Professional		$81.78	$99.56	$149.68
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.95 / $15.61 / $122.66	Professional	26	$12.95	$15.61	$122.66
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.83 / $83.16 / $122.66	Professional	TC	$68.83	$83.16	$122.66
United Facility/Professional Facility Modifier Low / Median / High Price $187.96 / $187.96 / $187.96	Facility		$187.96	$187.96	$187.96
United Facility/Professional Professional Modifier Low / Median / High Price $67.92 / $102.76 / $178.52	Professional		$67.92	$102.76	$178.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $18.23 / $29.47	Professional	26	$11.21	$18.23	$29.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.64 / $88.37 / $150.22	Professional	TC	$58.64	$88.37	$150.22