Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $213.80 / $489.78	Facility	26	$151.36	$213.80	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $323.59 / $812.83	Professional		$245.47	$323.59	$812.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $199.53 / $512.86	Professional	26	$131.83	$199.53	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $151.36 / $354.81	Professional	TC	$114.82	$151.36	$354.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $302.00 / $724.44	Professional		$245.47	$302.00	$724.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $154.88 / $371.54	Professional	26	$125.89	$154.88	$371.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $363.08	Professional	TC	$117.49	$151.36	$363.08
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $213.80 / $407.38	Professional		$190.55	$213.80	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $173.78 / $251.19	Facility	26	$37.15	$173.78	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $436.52 / $1,023.29	Professional		$257.04	$436.52	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $223.87 / $524.81	Professional	26	$131.83	$223.87	$524.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $218.78 / $501.19	Professional	TC	$125.89	$218.78	$501.19
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $398.11 / $616.60	Professional		$295.12	$398.11	$616.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $204.17 / $323.59	Professional	26	$154.88	$204.17	$323.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $194.98 / $288.40	Professional	TC	$147.91	$194.98	$288.40
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $288.40 / $537.03	Professional		$102.33	$288.40	$537.03
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $181.97 / $309.03	Professional	26	$128.82	$181.97	$309.03
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $134.90 / $251.19	Professional	TC	$61.66	$134.90	$251.19
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $323.59 / $478.63	Professional		$169.82	$323.59	$478.63
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $281.84 / $309.03	Professional	26	$169.82	$281.84	$309.03
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $398.11 / $758.58	Professional		$331.13	$398.11	$758.58
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $407.38	Professional	26	$173.78	$213.80	$407.38
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $186.21 / $354.81	Professional	TC	$158.49	$186.21	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $309.03 / $691.83	Professional		$229.09	$309.03	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $165.96 / $371.54	Professional	26	$117.49	$165.96	$371.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $151.36 / $338.84	Professional	TC	$109.65	$151.36	$338.84
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $162.18 / $234.42	Facility	26	$112.20	$162.18	$234.42
Univera Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $338.84 / $602.56	Professional		$223.87	$338.84	$602.56
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $190.55 / $323.59	Professional	26	$128.82	$190.55	$323.59
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $158.49 / $281.84	Professional	TC	$102.33	$158.49	$281.84