Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $42.66 / $93.33	Facility	26	$28.84	$42.66	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $295.12	Professional		$81.28	$123.03	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.20 / $95.50	Professional	26	$20.89	$30.20	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $93.33 / $204.17	Professional	TC	$66.07	$93.33	$204.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $97.72 / $263.03	Professional		$75.86	$97.72	$263.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $27.54 / $57.54	Professional	26	$21.88	$27.54	$57.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $67.61 / $190.55	Professional	TC	$54.95	$67.61	$190.55
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $147.91 / $190.55	Professional		$40.74	$147.91	$190.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $537.03	Professional		$97.72	$162.18	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $40.74 / $104.71	Professional	26	$21.88	$40.74	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $128.82 / $457.09	Professional	TC	$69.18	$128.82	$457.09
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $181.97 / $269.15	Professional		$138.04	$181.97	$269.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $91.20	Professional	26	$28.84	$39.81	$91.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $147.91 / $213.80	Professional	TC	$112.20	$147.91	$213.80
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $162.18 / $302.00	Professional		$67.61	$162.18	$302.00
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $36.31 / $66.07	Professional	26	$22.91	$36.31	$66.07
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $125.89 / $234.42	Professional	TC	$52.48	$125.89	$234.42
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Professional	26	$32.36	$32.36	$32.36
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $338.84	Professional		$141.25	$169.82	$338.84
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $40.74 / $74.13	Professional	26	$33.88	$40.74	$74.13
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $128.82 / $263.03	Professional	TC	$104.71	$128.82	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $251.19	Professional		$93.33	$125.89	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $58.88	Professional	26	$21.88	$29.51	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $95.50 / $194.98	Professional	TC	$72.44	$95.50	$194.98
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $33.11 / $87.10	Facility	26	$22.91	$33.11	$87.10
Univera Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $162.18 / $316.23	Professional		$67.61	$162.18	$316.23
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $36.31 / $74.13	Professional	26	$22.91	$36.31	$74.13
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $125.89 / $251.19	Professional	TC	$52.48	$125.89	$251.19