Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.74 / $67.50 / $147.34	Facility	26	$59.74	$67.50	$147.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.78 / $239.20 / $653.78	Professional		$128.78	$239.20	$653.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.15 / $63.00 / $177.84	Professional	26	$51.15	$63.00	$177.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $185.79 / $354.38	Professional	TC	$119.70	$185.79	$354.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.03 / $79.98 / $149.75	Professional		$58.03	$79.98	$149.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.69 / $52.09 / $80.33	Professional	26	$40.69	$52.09	$80.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.56 / $63.56 / $63.56	Professional	TC	$63.56	$63.56	$63.56
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $166.96 / $218.25 / $658.00	Professional		$166.96	$218.25	$658.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $64.45 / $134.65	Professional	26	$50.09	$64.45	$134.65
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.86 / $148.18 / $486.00	Professional	TC	$116.86	$148.18	$486.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $80.40 / $174.17 / $254.57	Professional		$80.40	$174.17	$254.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.78 / $362.22 / $873.12	Professional		$161.78	$362.22	$873.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.24 / $78.89 / $179.25	Professional	26	$41.24	$78.89	$179.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.20 / $277.27 / $625.23	Professional	TC	$110.20	$277.27	$625.23
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $174.36 / $236.35 / $446.15	Professional		$174.36	$236.35	$446.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.91 / $71.09 / $124.26	Professional	26	$51.91	$71.09	$124.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.01 / $152.91 / $278.70	Professional	TC	$117.01	$152.91	$278.70
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.36 / $255.31 / $355.20	Professional		$157.36	$255.31	$355.20
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $79.42 / $115.70	Professional	26	$40.90	$79.42	$115.70
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.02 / $183.80 / $239.50	Professional	TC	$103.02	$183.80	$239.50
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $110.64 / $117.79 / $201.45	Professional		$110.64	$117.79	$201.45
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $44.74 / $44.74 / $44.74	Professional	26	$44.74	$44.74	$44.74
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.97 / $215.25 / $414.93	Professional		$180.97	$215.25	$414.93
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.02 / $73.31 / $125.37	Professional	26	$61.02	$73.31	$125.37
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $142.07 / $142.07 / $160.59	Professional	TC	$142.07	$142.07	$160.59
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $193.73 / $307.56 / $853.23	Professional		$193.73	$307.56	$853.23
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $45.53 / $80.86 / $171.83	Professional	26	$45.53	$80.86	$171.83
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $126.36 / $196.96 / $488.99	Professional	TC	$126.36	$196.96	$488.99
United Facility/Professional Professional Modifier Low / Median / High Price $159.37 / $238.88 / $522.05	Professional		$159.37	$238.88	$522.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.43 / $64.20 / $141.74	Professional	26	$50.43	$64.20	$141.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.85 / $164.46 / $385.28	Professional	TC	$109.85	$164.46	$385.28
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $64.55 / $64.55 / $196.50	Facility	26	$64.55	$64.55	$196.50
Univera Facility/Professional Professional Modifier Low / Median / High Price $171.95 / $260.74 / $466.21	Professional		$171.95	$260.74	$466.21
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $84.93 / $151.38	Professional	26	$40.90	$84.93	$151.38
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $115.94 / $187.71 / $314.83	Professional	TC	$115.94	$187.71	$314.83