Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $135.27 / $165.34 / $299.89	Facility	26	$135.27	$165.34	$299.89
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $156.34 / $206.42 / $269.12	Facility	53	$156.34	$206.42	$269.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $754.15 / $977.87 / $2,268.14	Professional		$754.15	$977.87	$2,268.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.66 / $187.33 / $452.87	Professional	26	$115.66	$187.33	$452.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $357.10 / $463.33 / $802.69	Professional	52	$357.10	$463.33	$802.69
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $142.84 / $184.11 / $262.08	Professional	53	$142.84	$184.11	$262.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $618.97 / $786.48 / $1,697.59	Professional	TC	$618.97	$786.48	$1,697.59
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $656.58 / $832.53 / $2,125.00	Professional		$656.58	$832.53	$2,125.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.88 / $114.88 / $362.55	Professional	26	$87.88	$114.88	$362.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $568.70 / $706.23 / $1,672.72	Professional	TC	$568.70	$706.23	$1,672.72
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $180.39 / $1,035.97 / $1,216.35	Professional		$180.39	$1,035.97	$1,216.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $702.28 / $1,305.42 / $2,728.40	Professional		$702.28	$1,305.42	$2,728.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.35 / $214.58 / $419.10	Professional	26	$95.35	$214.58	$419.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $586.76 / $1,093.44 / $2,350.36	Professional	TC	$586.76	$1,093.44	$2,350.36
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $764.01 / $979.28 / $1,398.48	Professional		$764.01	$979.28	$1,398.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.69 / $151.63 / $226.92	Professional	26	$119.69	$151.63	$226.92
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $683.00 / $895.83 / $1,249.89	Professional	TC	$683.00	$895.83	$1,249.89
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $644.46 / $854.68 / $1,458.10	Professional		$644.46	$854.68	$1,458.10
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.29 / $142.13 / $237.14	Professional	26	$103.29	$142.13	$237.14
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $499.37 / $722.43 / $1,232.48	Professional	TC	$499.37	$722.43	$1,232.48
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
MVP Health Care Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $728.36 / $1,257.56 / $2,722.05	Professional		$728.36	$1,257.56	$2,722.05
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $109.98 / $187.80 / $402.82	Professional	26	$109.98	$187.80	$402.82
MVP Health Care Facility/Professional Professional Modifier 53 Low / Median / High Price $451.82 / $559.00 / $1,008.32	Professional	53	$451.82	$559.00	$1,008.32
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $608.03 / $1,005.37 / $2,350.36	Professional	TC	$608.03	$1,005.37	$2,350.36
United Facility/Professional Professional Modifier Low / Median / High Price $657.94 / $948.89 / $2,127.30	Professional		$657.94	$948.89	$2,127.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.64 / $149.80 / $351.50	Professional	26	$108.64	$149.80	$351.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $600.65 / $822.15 / $1,854.80	Professional	TC	$600.65	$822.15	$1,854.80
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $132.24 / $132.24 / $657.92	Facility	26	$132.24	$132.24	$657.92
Univera Facility/Professional Professional Modifier Low / Median / High Price $726.48 / $931.25 / $1,855.99	Professional		$726.48	$931.25	$1,855.99
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $112.40 / $151.11 / $285.79	Professional	26	$112.40	$151.11	$285.79
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $614.07 / $780.14 / $1,575.63	Professional	TC	$614.07	$780.14	$1,575.63