Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $84.84 / $327.68	Facility		$75.00	$84.84	$327.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.51 / $23.52 / $23.52	Facility	26	$23.51	$23.52	$23.52
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $51.47 / $51.48 / $357.73	Facility	TC	$51.47	$51.48	$357.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.74 / $49.58 / $91.14	Professional		$30.74	$49.58	$91.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.77 / $22.02 / $32.14	Professional	26	$17.77	$22.02	$32.14
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $234.74	Professional	50	$234.74	$234.74	$234.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.37 / $34.25 / $42.55	Professional	52	$15.37	$34.25	$42.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.38 / $49.11 / $64.06	Professional	TC	$13.38	$49.11	$64.06
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $35.89 / $55.49 / $93.03	Professional		$35.89	$55.49	$93.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $75.00 / $76.81	Facility		$75.00	$75.00	$76.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.91 / $23.91 / $23.91	Facility	26	$23.91	$23.91	$23.91
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $52.91 / $52.91 / $52.91	Facility	TC	$52.91	$52.91	$52.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.79 / $80.54 / $151.12	Professional		$26.79	$80.54	$151.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.52 / $27.19 / $47.65	Professional	26	$14.52	$27.19	$47.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.36 / $53.03 / $97.71	Professional	TC	$12.36	$53.03	$97.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.55 / $55.09 / $99.80	Professional		$42.55	$55.09	$99.80
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.21 / $29.70 / $38.34	Professional	26	$23.21	$29.70	$38.34
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.34 / $25.39 / $33.29	Professional	TC	$19.34	$25.39	$33.29
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $252.90 / $313.39 / $636.45	Facility		$252.90	$313.39	$636.45
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $37.77 / $82.89	Professional		$20.42	$37.77	$82.89
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.89 / $19.87 / $54.33	Professional	26	$16.89	$19.87	$54.33
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.44 / $40.79 / $115.37	Professional	TC	$27.44	$40.79	$115.37
United Facility/Professional Professional Modifier Low / Median / High Price $24.31 / $46.69 / $96.19	Professional		$24.31	$46.69	$96.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.94 / $22.01 / $37.29	Professional	26	$12.94	$22.01	$37.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.79 / $26.52 / $61.74	Professional	TC	$10.79	$26.52	$61.74