Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.36 / $55.56 / $91.24	Facility	26	$33.36	$55.56	$91.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.80 / $111.53 / $193.11	Professional		$70.80	$111.53	$193.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.19 / $71.06 / $125.53	Professional	TC	$39.19	$71.06	$125.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.19 / $89.15 / $288.07	Professional		$68.19	$89.15	$288.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.50 / $49.03 / $191.71	Professional	TC	$37.50	$49.03	$191.71
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $56.85 / $95.87 / $152.71	Professional		$56.85	$95.87	$152.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.78 / $161.76 / $345.26	Professional		$81.78	$161.76	$345.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.76 / $111.60 / $251.36	Professional	TC	$53.76	$111.60	$251.36
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $108.83 / $149.97 / $229.12	Professional		$108.83	$149.97	$229.12
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.72 / $91.15 / $146.03	Professional	TC	$69.72	$91.15	$146.03
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.45 / $140.66 / $230.09	Professional		$93.45	$140.66	$230.09
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $62.86 / $88.00 / $145.41	Professional	TC	$62.86	$88.00	$145.41
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $83.41 / $83.41 / $83.41	Professional		$83.41	$83.41	$83.41
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $45.47 / $45.47 / $45.47	Facility	26	$45.47	$45.47	$45.47
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $87.54 / $158.72 / $375.44	Professional		$87.54	$158.72	$375.44
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $53.89 / $96.13 / $223.56	Professional	TC	$53.89	$96.13	$223.56
United Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $120.56 / $268.62	Professional		$87.19	$120.56	$268.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.22 / $71.06 / $149.26	Professional	TC	$53.22	$71.06	$149.26
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $46.46 / $46.46 / $129.00	Facility	26	$46.46	$46.46	$129.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $93.45 / $159.61 / $291.17	Professional		$93.45	$159.61	$291.17
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $69.25 / $99.85 / $184.81	Professional	TC	$69.25	$99.85	$184.81