Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.05	Facility	26	$19.05	$19.05	$19.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.65 / $171.10 / $357.59	Professional		$75.65	$171.10	$357.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $30.56 / $56.17	Professional	26	$15.33	$30.56	$56.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.03 / $136.52 / $322.94	Professional	TC	$59.03	$136.52	$322.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.54 / $151.88 / $457.79	Professional		$64.54	$151.88	$457.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.29 / $27.18 / $113.16	Professional	26	$20.29	$27.18	$113.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.25 / $123.65 / $359.20	Professional	TC	$44.25	$123.65	$359.20
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $34.99 / $143.13 / $280.95	Professional		$34.99	$143.13	$280.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.94 / $90.94 / $90.94	Facility	26	$90.94	$90.94	$90.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.18 / $208.07 / $540.01	Professional		$93.18	$208.07	$540.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.37 / $32.53 / $94.57	Professional	26	$14.37	$32.53	$94.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.27 / $159.47 / $408.96	Professional	TC	$76.27	$159.47	$408.96
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $145.46 / $190.68 / $378.61	Professional		$145.46	$190.68	$378.61
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.90 / $20.18 / $41.08	Professional	26	$13.90	$20.18	$41.08
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.75 / $166.68 / $299.83	Professional	TC	$109.75	$166.68	$299.83
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.63 / $266.08 / $421.91	Professional		$162.63	$266.08	$421.91
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.68 / $32.84 / $49.19	Professional	26	$21.68	$32.84	$49.19
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $143.68 / $233.95 / $372.72	Professional	TC	$143.68	$233.95	$372.72
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $90.94 / $90.94 / $90.94	Facility	26	$90.94	$90.94	$90.94
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $96.47 / $188.58 / $503.56	Professional		$96.47	$188.58	$503.56
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $13.23 / $28.57 / $81.58	Professional	26	$13.23	$28.57	$81.58
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $76.38 / $166.58 / $397.05	Professional	TC	$76.38	$166.58	$397.05
United Facility/Professional Professional Modifier Low / Median / High Price $98.53 / $132.38 / $334.38	Professional		$98.53	$132.38	$334.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.85 / $20.00 / $48.55	Professional	26	$12.85	$20.00	$48.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.76 / $111.79 / $276.98	Professional	TC	$84.76	$111.79	$276.98
Univera Facility/Professional Professional Modifier Low / Median / High Price $179.49 / $271.43 / $539.75	Professional		$179.49	$271.43	$539.75
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $21.68 / $31.65 / $63.90	Professional	26	$21.68	$31.65	$63.90
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $157.81 / $239.08 / $475.85	Professional	TC	$157.81	$239.08	$475.85