Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.49 / $62.90 / $117.11	Facility	26	$50.49	$62.90	$117.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.26 / $170.64 / $334.44	Professional		$133.26	$170.64	$334.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $62.90 / $126.22	Professional	26	$46.10	$62.90	$126.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.26 / $105.44 / $187.09	Professional	TC	$84.26	$105.44	$187.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.48 / $109.66 / $131.54	Professional		$91.48	$109.66	$131.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.29 / $40.31 / $72.48	Professional	26	$37.29	$40.31	$72.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $137.07 / $168.42 / $369.40	Professional		$137.07	$168.42	$369.40
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.85 / $56.44 / $122.12	Professional	26	$46.85	$56.44	$122.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $90.21 / $108.67 / $227.16	Professional	TC	$90.21	$108.67	$227.16
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $74.48 / $133.58 / $208.08	Professional		$74.48	$133.58	$208.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.19 / $223.62 / $527.09	Professional		$115.19	$223.62	$527.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $70.62 / $155.77	Professional	26	$38.58	$70.62	$155.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.26 / $143.60 / $372.69	Professional	TC	$75.26	$143.60	$372.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $140.76 / $189.45 / $291.94	Professional		$140.76	$189.45	$291.94
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.89 / $67.03 / $105.80	Professional	26	$49.89	$67.03	$105.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $90.85 / $118.64 / $190.50	Professional	TC	$90.85	$118.64	$190.50
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.65 / $150.59 / $292.55	Professional		$114.65	$150.59	$292.55
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.09 / $85.60 / $107.18	Professional	26	$43.09	$85.60	$107.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.14 / $96.68 / $185.37	Professional	TC	$50.14	$96.68	$185.37
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $140.05 / $142.22 / $151.55	Professional		$140.05	$142.22	$151.55
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $65.50 / $74.08 / $77.98	Professional	26	$65.50	$74.08	$77.98
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.94 / $171.58 / $336.39	Professional		$145.94	$171.58	$336.39
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.27 / $61.43 / $108.12	Professional	26	$59.27	$61.43	$108.12
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.95 / $120.22 / $123.83	Professional	TC	$108.95	$120.22	$123.83
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $131.47 / $207.71 / $448.33	Professional		$131.47	$207.71	$448.33
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $39.04 / $69.36 / $150.72	Professional	26	$39.04	$69.36	$150.72
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $76.14 / $132.38 / $297.61	Professional	TC	$76.14	$132.38	$297.61
United Facility/Professional Professional Modifier Low / Median / High Price $129.91 / $165.97 / $339.02	Professional		$129.91	$165.97	$339.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.20 / $57.34 / $119.75	Professional	26	$43.20	$57.34	$119.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $109.52 / $239.45	Professional	TC	$80.59	$109.52	$239.45
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $59.79 / $59.79 / $76.19	Facility	26	$59.79	$59.79	$76.19
Univera Facility/Professional Professional Modifier Low / Median / High Price $141.62 / $212.84 / $358.43	Professional		$141.62	$212.84	$358.43
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $51.89 / $85.60 / $131.32	Professional	26	$51.89	$85.60	$131.32
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $50.14 / $136.07 / $227.11	Professional	TC	$50.14	$136.07	$227.11