Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.03 / $121.03 / $1,016.69	Facility		$121.03	$121.03	$1,016.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.07 / $19.07 / $19.07	Facility	26	$19.07	$19.07	$19.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.06 / $90.42 / $166.05	Professional		$60.06	$90.42	$166.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.83 / $18.29 / $25.67	Professional	26	$14.83	$18.29	$25.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.33 / $82.28 / $147.55	Professional	TC	$43.33	$82.28	$147.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $59.52 / $59.52 / $59.52	Professional		$59.52	$59.52	$59.52
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $75.37 / $75.37 / $75.37	Professional		$75.37	$75.37	$75.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $55.78 / $101.82 / $645.85	Facility		$55.78	$101.82	$645.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.57 / $19.57 / $19.57	Facility	26	$19.57	$19.57	$19.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.82 / $131.88 / $294.47	Professional		$51.82	$131.88	$294.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.53 / $25.09 / $46.31	Professional	26	$13.53	$25.09	$46.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.28 / $104.04 / $248.06	Professional	TC	$38.28	$104.04	$248.06
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $77.54 / $101.04 / $247.00	Professional		$77.54	$101.04	$247.00
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $26.30 / $247.00	Professional	26	$20.35	$26.30	$247.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.19 / $74.73 / $247.00	Professional	TC	$57.19	$74.73	$247.00
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $729.14 / $757.08 / $1,537.57	Facility		$729.14	$757.08	$1,537.57
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.18 / $65.34 / $173.95	Professional		$53.18	$65.34	$173.95
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $17.30 / $60.83	Professional	26	$14.32	$17.30	$60.83
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.86 / $48.05 / $108.64	Professional	TC	$38.86	$48.05	$108.64
United Facility/Professional Professional Modifier Low / Median / High Price $49.77 / $79.59 / $166.18	Professional		$49.77	$79.59	$166.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.24 / $20.74 / $40.20	Professional	26	$13.24	$20.74	$40.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.93 / $66.66 / $131.09	Professional	TC	$39.93	$66.66	$131.09