Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.17 / $85.82 / $200.14	Facility	26	$58.17	$85.82	$200.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.52 / $289.29 / $589.90	Professional		$206.52	$289.29	$589.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.45 / $66.27 / $110.01	Professional	26	$50.45	$66.27	$110.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.58 / $208.50 / $541.52	Professional	TC	$149.58	$208.50	$541.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.28 / $236.98 / $699.30	Professional		$181.28	$236.98	$699.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.34 / $65.81 / $143.65	Professional	26	$50.34	$65.81	$143.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $130.94 / $171.17 / $514.72	Professional	TC	$130.94	$171.17	$514.72
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $88.23 / $242.92 / $331.15	Professional		$88.23	$242.92	$331.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.81 / $69.81 / $69.81	Facility	26	$69.81	$69.81	$69.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.98 / $408.19 / $1,105.48	Professional		$169.98	$408.19	$1,105.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.97 / $85.50 / $186.19	Professional	26	$43.97	$85.50	$186.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.01 / $299.58 / $943.03	Professional	TC	$126.01	$299.58	$943.03
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $225.37 / $305.50 / $632.74	Professional		$225.37	$305.50	$632.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.68 / $80.16 / $126.90	Professional	26	$57.68	$80.16	$126.90
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $157.15 / $217.83 / $380.74	Professional	TC	$157.15	$217.83	$380.74
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.44 / $330.78 / $415.50	Professional		$182.44	$330.78	$415.50
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $61.92 / $118.53	Professional	26	$40.09	$61.92	$118.53
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.94 / $257.23 / $356.89	Professional	TC	$132.94	$257.23	$356.89
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $69.81 / $69.81 / $69.81	Facility	26	$69.81	$69.81	$69.81
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $169.98 / $341.76 / $1,377.28	Professional		$169.98	$341.76	$1,377.28
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $45.05 / $85.50 / $184.54	Professional	26	$45.05	$85.50	$184.54
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $129.01 / $230.97 / $784.33	Professional	TC	$129.01	$230.97	$784.33
United Facility/Professional Professional Modifier Low / Median / High Price $197.17 / $307.57 / $765.66	Professional		$197.17	$307.57	$765.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.25 / $69.72 / $149.56	Professional	26	$49.25	$69.72	$149.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.24 / $208.68 / $696.44	Professional	TC	$142.24	$208.68	$696.44
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $65.45 / $65.45 / $169.44	Facility	26	$65.45	$65.45	$169.44
Univera Facility/Professional Professional Modifier Low / Median / High Price $202.19 / $359.90 / $634.23	Professional		$202.19	$359.90	$634.23
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $93.89 / $156.71	Professional	26	$40.09	$93.89	$156.71
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $144.51 / $257.23 / $457.11	Professional	TC	$144.51	$257.23	$457.11