Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.19 / $38.50 / $69.23	Facility	26	$23.19	$38.50	$69.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.83 / $77.64 / $132.21	Professional		$58.83	$77.64	$132.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.19 / $29.85 / $61.37	Professional	26	$23.19	$29.85	$61.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.81 / $33.72 / $60.21	Professional	52	$27.81	$33.72	$60.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.80 / $43.74 / $71.43	Professional	TC	$31.80	$43.74	$71.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.22 / $99.09 / $184.12	Professional		$82.22	$99.09	$184.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.43 / $41.87 / $70.06	Professional	26	$34.43	$41.87	$70.06
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $123.33 / $148.63 / $274.17	Professional	50	$123.33	$148.63	$274.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $46.86 / $57.21 / $103.85	Professional	TC	$46.86	$57.21	$103.85
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $43.13 / $51.46 / $94.59	Professional		$43.13	$51.46	$94.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.16 / $106.12 / $222.14	Professional		$60.16	$106.12	$222.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $41.57 / $90.55	Professional	26	$22.87	$41.57	$90.55
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $85.56 / $85.56 / $85.56	Professional	50	$85.56	$85.56	$85.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.52 / $62.67 / $140.13	Professional	TC	$31.52	$62.67	$140.13
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $69.56 / $89.90 / $141.44	Professional		$69.56	$89.90	$141.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.45 / $39.04 / $62.59	Professional	26	$28.45	$39.04	$62.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.03 / $50.63 / $92.52	Professional	TC	$40.03	$50.63	$92.52
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.55 / $80.23 / $143.80	Professional		$52.55	$80.23	$143.80
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $39.83 / $63.86	Professional	26	$16.55	$39.83	$63.86
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.82 / $48.89 / $79.95	Professional	TC	$30.82	$48.89	$79.95
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $33.84 / $33.84 / $33.84	Facility	26	$33.84	$33.84	$33.84
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $66.88 / $100.05 / $205.06	Professional		$66.88	$100.05	$205.06
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $24.16 / $41.15 / $86.14	Professional	26	$24.16	$41.15	$86.14
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $85.56 / $85.56 / $85.56	Professional	50	$85.56	$85.56	$85.56
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $35.07 / $52.10 / $125.93	Professional	TC	$35.07	$52.10	$125.93
United Facility/Professional Professional Modifier Low / Median / High Price $52.82 / $74.29 / $164.01	Professional		$52.82	$74.29	$164.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.48 / $31.32 / $70.38	Professional	26	$23.48	$31.32	$70.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.05 / $40.75 / $91.62	Professional	TC	$29.05	$40.75	$91.62
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $35.04 / $35.04 / $92.68	Facility	26	$35.04	$35.04	$92.68
Univera Facility/Professional Professional Modifier Low / Median / High Price $52.55 / $91.19 / $178.24	Professional		$52.55	$91.19	$178.24
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $16.55 / $40.49 / $80.23	Professional	26	$16.55	$40.49	$80.23
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $36.00 / $50.70 / $98.01	Professional	TC	$36.00	$50.70	$98.01