Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.08 / $60.51 / $82.19	Facility	26	$45.08	$60.51	$82.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.05 / $99.88 / $143.88	Professional		$81.05	$99.88	$143.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.84 / $53.95 / $78.02	Professional	TC	$42.84	$53.95	$78.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.76 / $79.75 / $188.78	Professional		$62.76	$79.75	$188.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.79 / $39.11 / $103.25	Professional	TC	$30.79	$39.11	$103.25
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $67.64 / $81.92 / $149.56	Professional		$67.64	$81.92	$149.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.06 / $52.06 / $52.06	Facility	26	$52.06	$52.06	$52.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.81 / $138.62 / $352.12	Professional		$78.81	$138.62	$352.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.13 / $74.92 / $182.41	Professional	TC	$41.13	$74.92	$182.41
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $93.62 / $126.55 / $179.72	Professional		$93.62	$126.55	$179.72
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.06 / $67.64 / $89.93	Professional	TC	$52.06	$67.64	$89.93
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.34 / $94.82 / $217.29	Professional		$77.34	$94.82	$217.29
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.89 / $49.67 / $112.07	Professional	TC	$39.89	$49.67	$112.07
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $95.45 / $95.45 / $95.45	Professional		$95.45	$95.45	$95.45
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $52.06 / $52.06 / $52.06	Facility	26	$52.06	$52.06	$52.06
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $77.23 / $141.65 / $307.44	Professional		$77.23	$141.65	$307.44
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $42.50 / $72.41 / $174.59	Professional	TC	$42.50	$72.41	$174.59
United Facility/Professional Professional Modifier Low / Median / High Price $80.09 / $108.95 / $259.38	Professional		$80.09	$108.95	$259.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.43 / $60.31 / $139.91	Professional	TC	$43.43	$60.31	$139.91
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $53.56 / $53.56 / $183.65	Facility	26	$53.56	$53.56	$183.65
Univera Facility/Professional Professional Modifier Low / Median / High Price $83.52 / $110.60 / $241.78	Professional		$83.52	$110.60	$241.78
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $45.53 / $56.27 / $124.70	Professional	TC	$45.53	$56.27	$124.70