Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.05 / $20.05 / $20.05	Facility	26	$20.05	$20.05	$20.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.76 / $56.65 / $131.83	Professional		$40.76	$56.65	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.61 / $21.91 / $46.95	Professional	26	$15.61	$21.91	$46.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.78 / $34.72 / $88.25	Professional	TC	$24.78	$34.72	$88.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.93 / $76.16 / $173.81	Professional		$26.93	$76.16	$173.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.51 / $29.04 / $61.15	Professional	26	$10.51	$29.04	$61.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.42 / $45.68 / $108.36	Professional	TC	$16.42	$45.68	$108.36
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $50.58 / $99.28	Professional		$32.29	$50.58	$99.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.25 / $40.25 / $40.25	Facility	26	$40.25	$40.25	$40.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.82 / $78.40 / $186.15	Professional		$32.82	$78.40	$186.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.41 / $29.60 / $62.02	Professional	26	$13.41	$29.60	$62.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.80 / $46.34 / $119.74	Professional	TC	$18.80	$46.34	$119.74
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $53.16 / $80.94 / $148.13	Professional		$53.16	$80.94	$148.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.21 / $22.22 / $44.59	Professional	26	$15.21	$22.22	$44.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.95 / $57.73 / $103.55	Professional	TC	$37.95	$57.73	$103.55
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $88.17 / $171.36	Professional		$49.00	$88.17	$171.36
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.26 / $27.05 / $52.56	Professional	26	$20.26	$27.05	$52.56
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.68 / $61.13 / $118.79	Professional	TC	$28.68	$61.13	$118.79
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.69 / $16.69 / $16.69	Professional	26	$16.69	$16.69	$16.69
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $40.25 / $40.25 / $40.25	Facility	26	$40.25	$40.25	$40.25
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $30.56 / $81.51 / $173.35	Professional		$30.56	$81.51	$173.35
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $13.41 / $25.85 / $52.59	Professional	26	$13.41	$25.85	$52.59
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $19.55 / $51.31 / $105.38	Professional	TC	$19.55	$51.31	$105.38
United Facility/Professional Professional Modifier Low / Median / High Price $33.79 / $48.91 / $118.61	Professional		$33.79	$48.91	$118.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.04 / $17.48 / $40.07	Professional	26	$13.04	$17.48	$40.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.54 / $31.81 / $80.03	Professional	TC	$23.54	$31.81	$80.03
Univera Facility/Professional Professional Modifier Low / Median / High Price $55.07 / $88.17 / $206.45	Professional		$55.07	$88.17	$206.45
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $22.03 / $27.05 / $63.34	Professional	26	$22.03	$27.05	$63.34
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $33.36 / $61.13 / $138.22	Professional	TC	$33.36	$61.13	$138.22