Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.55 / $62.68 / $98.68	Facility	26	$28.55	$62.68	$98.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.03 / $212.92 / $378.94	Professional		$153.03	$212.92	$378.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.48 / $168.60 / $322.00	Professional	TC	$124.48	$168.60	$322.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.76 / $240.53 / $514.24	Professional		$185.76	$240.53	$514.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $150.33 / $190.61 / $415.13	Professional	TC	$150.33	$190.61	$415.13
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $62.78 / $247.87 / $310.64	Professional		$62.78	$247.87	$310.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.71 / $48.71 / $48.71	Facility	26	$48.71	$48.71	$48.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.11 / $301.56 / $800.44	Professional		$166.11	$301.56	$800.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.77 / $254.98 / $754.62	Professional	TC	$130.77	$254.98	$754.62
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $191.63 / $280.10 / $415.40	Professional		$191.63	$280.10	$415.40
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.29 / $208.03 / $345.49	Professional	TC	$148.29	$208.03	$345.49
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $116.15 / $188.82 / $324.60	Professional		$116.15	$188.82	$324.60
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.69 / $150.93 / $256.33	Professional	TC	$69.69	$150.93	$256.33
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $48.71 / $48.71 / $48.71	Facility	26	$48.71	$48.71	$48.71
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $179.98 / $320.01 / $797.35	Professional		$179.98	$320.01	$797.35
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $144.56 / $241.81 / $651.50	Professional	TC	$144.56	$241.81	$651.50
United Facility/Professional Professional Modifier Low / Median / High Price $194.47 / $264.39 / $530.20	Professional		$194.47	$264.39	$530.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.76 / $210.86 / $575.53	Professional	TC	$157.76	$210.86	$575.53
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $45.67 / $45.67 / $149.00	Facility	26	$45.67	$45.67	$149.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $174.76 / $273.57 / $587.64	Professional		$174.76	$273.57	$587.64
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $148.29 / $216.03 / $464.05	Professional	TC	$148.29	$216.03	$464.05