Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.17 / $69.17 / $69.17	Facility	26	$69.17	$69.17	$69.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.36 / $99.76 / $238.16	Professional		$82.36	$99.76	$238.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.40 / $77.13 / $172.09	Professional	26	$53.40	$77.13	$172.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.13 / $38.97 / $69.36	Professional	TC	$22.13	$38.97	$69.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.87 / $131.71 / $345.08	Professional		$54.87	$131.71	$345.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.58 / $92.61 / $213.27	Professional	26	$36.58	$92.61	$213.27
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.33 / $35.39 / $126.96	Professional	TC	$22.33	$35.39	$126.96
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $81.97 / $160.88	Professional		$37.14	$81.97	$160.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $133.12 / $133.12 / $133.12	Facility	26	$133.12	$133.12	$133.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.45 / $131.19 / $300.38	Professional		$66.45	$131.19	$300.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.31 / $100.05 / $216.35	Professional	26	$46.31	$100.05	$216.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.04 / $37.57 / $109.07	Professional	TC	$17.04	$37.57	$109.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $84.77 / $107.64 / $220.64	Professional		$84.77	$107.64	$220.64
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.87 / $76.87 / $155.94	Professional	26	$52.87	$76.87	$155.94
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.19 / $29.18 / $52.36	Professional	TC	$19.19	$29.18	$52.36
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.63 / $158.69 / $246.69	Professional		$109.63	$158.69	$246.69
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $71.26 / $118.92 / $184.85	Professional	26	$71.26	$118.92	$184.85
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.56 / $41.75 / $61.84	Professional	TC	$27.56	$41.75	$61.84
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $39.25 / $39.25 / $39.25	Professional		$39.25	$39.25	$39.25
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $82.08 / $82.08 / $82.08	Professional	26	$82.08	$82.08	$82.08
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $133.12 / $133.12 / $133.12	Facility	26	$133.12	$133.12	$133.12
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $3.30 / $114.87 / $322.89	Professional		$3.30	$114.87	$322.89
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $45.39 / $84.70 / $181.72	Professional	26	$45.39	$84.70	$181.72
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $16.59 / $35.50 / $97.54	Professional	TC	$16.59	$35.50	$97.54
United Facility/Professional Professional Modifier Low / Median / High Price $57.48 / $79.75 / $201.44	Professional		$57.48	$79.75	$201.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.24 / $59.85 / $144.07	Professional	26	$41.24	$59.85	$144.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.19 / $22.24 / $56.57	Professional	TC	$15.19	$22.24	$56.57
Univera Facility/Professional Professional Modifier Low / Median / High Price $109.63 / $158.69 / $310.12	Professional		$109.63	$158.69	$310.12
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $82.08 / $118.92 / $235.20	Professional	26	$82.08	$118.92	$235.20
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $27.56 / $39.78 / $74.92	Professional	TC	$27.56	$39.78	$74.92