Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $21.19 / $40.21	Facility	26	$15.49	$21.19	$40.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.45 / $76.09 / $216.00	Professional		$49.45	$76.09	$216.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $21.26 / $77.09	Professional	26	$16.27	$21.26	$77.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.10 / $45.64 / $94.39	Professional	TC	$32.10	$45.64	$94.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.05 / $90.05 / $90.05	Professional		$90.05	$90.05	$90.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.28 / $31.28 / $31.28	Professional	26	$31.28	$31.28	$31.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.74 / $61.81 / $158.15	Professional		$48.74	$61.81	$158.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.51 / $20.28 / $46.74	Professional	26	$15.51	$20.28	$46.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.22 / $42.13 / $100.10	Professional	TC	$33.22	$42.13	$100.10
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $25.58 / $49.55 / $75.13	Professional		$25.58	$49.55	$75.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.30 / $97.37 / $205.20	Professional		$53.30	$97.37	$205.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.00 / $29.22 / $59.23	Professional	26	$17.00	$29.22	$59.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $70.20 / $133.47	Professional	TC	$36.34	$70.20	$133.47
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $58.43 / $84.71 / $97.42	Professional		$58.43	$84.71	$97.42
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.92 / $23.30 / $35.85	Professional	26	$17.92	$23.30	$35.85
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.51 / $46.69 / $94.14	Professional	TC	$37.51	$46.69	$94.14
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.24 / $74.45 / $106.98	Professional		$41.24	$74.45	$106.98
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $24.46 / $37.47	Professional	26	$14.95	$24.46	$37.47
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.79 / $52.72 / $69.50	Professional	TC	$26.79	$52.72	$69.50
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $48.07 / $48.07 / $48.07	Professional		$48.07	$48.07	$48.07
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $15.22 / $16.67 / $21.48	Professional	26	$15.22	$16.67	$21.48
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $53.61 / $89.20 / $205.70	Professional		$53.61	$89.20	$205.70
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $18.18 / $26.03 / $55.65	Professional	26	$18.18	$26.03	$55.65
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $36.34 / $60.89 / $129.06	Professional	TC	$36.34	$60.89	$129.06
United Facility/Professional Professional Modifier Low / Median / High Price $49.80 / $70.09 / $145.22	Professional		$49.80	$70.09	$145.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.35 / $23.03 / $47.37	Professional	26	$17.35	$23.03	$47.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.54 / $44.99 / $101.67	Professional	TC	$32.54	$44.99	$101.67
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $24.46 / $24.46 / $75.47	Facility	26	$24.46	$24.46	$75.47
Univera Facility/Professional Professional Modifier Low / Median / High Price $54.82 / $74.33 / $155.46	Professional		$54.82	$74.33	$155.46
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $17.10 / $25.72 / $54.47	Professional	26	$17.10	$25.72	$54.47
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $35.61 / $48.29 / $100.99	Professional	TC	$35.61	$48.29	$100.99