Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.22 / $73.48 / $162.80	Facility	26	$54.22	$73.48	$162.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.93 / $287.10 / $976.51	Professional		$210.93	$287.10	$976.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.49 / $76.69 / $287.61	Professional	26	$56.49	$76.69	$287.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.75 / $184.07 / $443.73	Professional	TC	$152.75	$184.07	$443.73
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.44 / $265.05 / $637.96	Professional		$213.44	$265.05	$637.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.30 / $67.63 / $159.88	Professional	26	$54.30	$67.63	$159.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $159.13 / $197.61 / $403.93	Professional	TC	$159.13	$197.61	$403.93
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $88.46 / $239.48 / $327.94	Professional		$88.46	$239.48	$327.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.22 / $347.25 / $760.33	Professional		$232.22	$347.25	$760.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.40 / $97.11 / $205.76	Professional	26	$59.40	$97.11	$205.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $171.56 / $252.21 / $587.40	Professional	TC	$171.56	$252.21	$587.40
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $221.66 / $297.18 / $439.23	Professional		$221.66	$297.18	$439.23
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.60 / $80.70 / $125.66	Professional	26	$58.60	$80.70	$125.66
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.51 / $221.04 / $313.57	Professional	TC	$166.51	$221.04	$313.57
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.52 / $256.33 / $462.09	Professional		$159.52	$256.33	$462.09
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.02 / $77.68 / $129.61	Professional	26	$50.02	$77.68	$129.61
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.97 / $184.43 / $332.48	Professional	TC	$107.97	$184.43	$332.48
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $233.38 / $335.63 / $739.47	Professional		$233.38	$335.63	$739.47
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $62.81 / $90.35 / $192.42	Professional	26	$62.81	$90.35	$192.42
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $171.86 / $239.37 / $563.83	Professional	TC	$171.86	$239.37	$563.83
United Facility/Professional Professional Modifier Low / Median / High Price $213.72 / $283.30 / $584.50	Professional		$213.72	$283.30	$584.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.93 / $78.75 / $176.72	Professional	26	$59.93	$78.75	$176.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.83 / $211.87 / $447.94	Professional	TC	$154.83	$211.87	$447.94
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $84.58 / $84.58 / $254.43	Facility	26	$84.58	$84.58	$254.43
Univera Facility/Professional Professional Modifier Low / Median / High Price $201.05 / $301.56 / $671.47	Professional		$201.05	$301.56	$671.47
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $56.21 / $84.58 / $188.34	Professional	26	$56.21	$84.58	$188.34
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $144.85 / $216.98 / $479.04	Professional	TC	$144.85	$216.98	$479.04