Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.85 / $83.37 / $107.16	Facility	26	$55.85	$83.37	$107.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $367.80 / $445.38 / $706.09	Professional		$367.80	$445.38	$706.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.19 / $65.43 / $98.80	Professional	26	$53.19	$65.43	$98.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $183.90 / $214.05 / $333.75	Professional	52	$183.90	$214.05	$333.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $313.45 / $378.40 / $613.55	Professional	TC	$313.45	$378.40	$613.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $357.40 / $443.83 / $933.90	Professional		$357.40	$443.83	$933.90
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $60.20 / $121.52	Professional	26	$48.47	$60.20	$121.52
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $308.92 / $381.80 / $794.48	Professional	TC	$308.92	$381.80	$794.48
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $86.40 / $471.76 / $558.16	Professional		$86.40	$471.76	$558.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $306.36 / $719.14 / $1,430.10	Professional		$306.36	$719.14	$1,430.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.73 / $98.77 / $194.13	Professional	26	$44.73	$98.77	$194.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $261.63 / $621.74 / $1,235.81	Professional	TC	$261.63	$621.74	$1,235.81
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $442.69 / $585.82 / $841.11	Professional		$442.69	$585.82	$841.11
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.62 / $79.66 / $119.22	Professional	26	$59.62	$79.66	$119.22
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $421.38 / $546.87 / $727.83	Professional	TC	$421.38	$546.87	$727.83
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $382.24 / $512.21 / $930.41	Professional		$382.24	$512.21	$930.41
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.54 / $73.61 / $135.60	Professional	26	$51.54	$73.61	$135.60
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $327.31 / $438.59 / $794.81	Professional	TC	$327.31	$438.59	$794.81
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $405.00 / $671.27 / $1,399.35	Professional		$405.00	$671.27	$1,399.35
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $48.24 / $90.53 / $192.27	Professional	26	$48.24	$90.53	$192.27
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $336.95 / $569.34 / $1,205.47	Professional	TC	$336.95	$569.34	$1,205.47
United Facility/Professional Professional Modifier Low / Median / High Price $356.01 / $491.10 / $1,230.08	Professional		$356.01	$491.10	$1,230.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.19 / $71.41 / $165.67	Professional	26	$52.19	$71.41	$165.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $300.35 / $417.16 / $1,064.46	Professional	TC	$300.35	$417.16	$1,064.46
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $69.02 / $69.02 / $296.94	Facility	26	$69.02	$69.02	$296.94
Univera Facility/Professional Professional Modifier Low / Median / High Price $402.54 / $518.02 / $1,029.36	Professional		$402.54	$518.02	$1,029.36
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $58.67 / $74.45 / $150.02	Professional	26	$58.67	$74.45	$150.02
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $343.88 / $443.57 / $879.34	Professional	TC	$343.88	$443.57	$879.34