Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.20 / $167.33 / $393.27	Facility		$75.20	$167.33	$393.27
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.34 / $38.34 / $222.91	Facility	26	$38.34	$38.34	$222.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $78.55 / $135.43	Professional		$44.67	$78.55	$135.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $43.20 / $69.59	Professional	26	$26.78	$43.20	$69.59
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $179.00 / $179.00 / $205.00	Professional	50	$179.00	$179.00	$205.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.57 / $36.86 / $59.49	Professional	TC	$15.57	$36.86	$59.49
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $69.97 / $69.97 / $69.97	Professional		$69.97	$69.97	$69.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $44.35 / $55.74 / $84.44	Facility		$44.35	$55.74	$84.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.96 / $106.20 / $191.87	Professional		$45.96	$106.20	$191.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $56.61 / $104.45	Professional	26	$23.52	$56.61	$104.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.34 / $51.37 / $95.27	Professional	TC	$16.34	$51.37	$95.27
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $53.52 / $72.47 / $157.47	Professional		$53.52	$72.47	$157.47
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $40.15 / $68.06	Professional	26	$32.72	$40.15	$68.06
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.80 / $25.06 / $43.26	Professional	TC	$20.80	$25.06	$43.26
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $258.52 / $525.08 / $2,189.00	Facility		$258.52	$525.08	$2,189.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $27.51 / $49.37 / $95.43	Professional		$27.51	$49.37	$95.43
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.04 / $30.63 / $59.86	Professional	26	$26.04	$30.63	$59.86
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.98 / $22.34 / $81.12	Professional	TC	$18.98	$22.34	$81.12
United Facility/Professional Facility Modifier Low / Median / High Price $143.22 / $177.90 / $272.43	Facility		$143.22	$177.90	$272.43
United Facility/Professional Professional Modifier Low / Median / High Price $36.00 / $67.64 / $116.23	Professional		$36.00	$67.64	$116.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.33 / $38.67 / $73.41	Professional	26	$22.33	$38.67	$73.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $14.03 / $29.34 / $63.24	Professional	TC	$14.03	$29.34	$63.24