Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.49 / $44.80 / $73.28	Facility	26	$26.49	$44.80	$73.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.41 / $88.17 / $249.07	Professional		$70.41	$88.17	$249.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.48 / $32.57 / $76.12	Professional	26	$26.48	$32.57	$76.12
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $175.64 / $197.14 / $406.09	Professional	50	$175.64	$197.14	$406.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.94 / $55.25 / $105.40	Professional	TC	$37.94	$55.25	$105.40
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $91.26 / $211.01	Professional		$73.48	$91.26	$211.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.56 / $34.95 / $78.22	Professional	26	$27.56	$34.95	$78.22
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $110.24 / $136.88 / $314.77	Professional	50	$110.24	$136.88	$314.77
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $45.93 / $57.03 / $132.38	Professional	TC	$45.93	$57.03	$132.38
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $45.65 / $64.83 / $110.48	Professional		$45.65	$64.83	$110.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.12 / $131.99 / $283.58	Professional		$70.12	$131.99	$283.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $46.79 / $102.73	Professional	26	$24.90	$46.79	$102.73
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $126.81 / $126.81 / $126.81	Professional	50	$126.81	$126.81	$126.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.96 / $80.98 / $170.35	Professional	TC	$37.96	$80.98	$170.35
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $100.49 / $152.46	Professional		$75.95	$100.49	$152.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $41.50 / $66.86	Professional	26	$30.39	$41.50	$66.86
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.58 / $56.42 / $85.69	Professional	TC	$44.58	$56.42	$85.69
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.19 / $89.98 / $158.65	Professional		$59.19	$89.98	$158.65
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.59 / $42.54 / $68.26	Professional	26	$18.59	$42.54	$68.26
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.36 / $54.48 / $90.39	Professional	TC	$36.36	$54.48	$90.39
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $80.56 / $136.97 / $262.33	Professional		$80.56	$136.97	$262.33
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $26.39 / $47.04 / $97.27	Professional	26	$26.39	$47.04	$97.27
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $126.81 / $126.81 / $126.81	Professional	50	$126.81	$126.81	$126.81
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $46.01 / $81.05 / $158.34	Professional	TC	$46.01	$81.05	$158.34
United Facility/Professional Professional Modifier Low / Median / High Price $66.92 / $97.49 / $217.80	Professional		$66.92	$97.49	$217.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.49 / $35.29 / $79.15	Professional	26	$24.49	$35.29	$79.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.40 / $61.40 / $142.57	Professional	TC	$42.40	$61.40	$142.57
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $37.46 / $37.46 / $113.47	Facility	26	$37.46	$37.46	$113.47
Univera Facility/Professional Professional Modifier Low / Median / High Price $59.19 / $100.61 / $198.67	Professional		$59.19	$100.61	$198.67
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $18.59 / $43.29 / $85.75	Professional	26	$18.59	$43.29	$85.75
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $57.32 / $112.91	Professional	TC	$40.60	$57.32	$112.91