Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.78 / $17.61 / $33.11	Facility	26	$13.78	$17.61	$33.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.50 / $67.65 / $157.54	Professional		$43.50	$67.65	$157.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.55 / $16.82 / $38.99	Professional	26	$13.55	$16.82	$38.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.71 / $48.13 / $100.84	Professional	TC	$29.71	$48.13	$100.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.36 / $40.36 / $48.65	Professional		$40.36	$40.36	$48.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.60 / $16.44 / $20.55	Professional	26	$10.60	$16.44	$20.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.44 / $59.85 / $163.74	Professional		$46.44	$59.85	$163.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.72 / $12.71 / $38.85	Professional	26	$9.72	$12.71	$38.85
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.06 / $45.72 / $108.81	Professional	TC	$36.06	$45.72	$108.81
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $20.63 / $66.26 / $86.89	Professional		$20.63	$66.26	$86.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.40 / $90.07 / $222.72	Professional		$49.40	$90.07	$222.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.19 / $22.20 / $48.63	Professional	26	$11.19	$22.20	$48.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.49 / $68.37 / $174.09	Professional	TC	$36.49	$68.37	$174.09
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $57.66 / $78.51 / $126.24	Professional		$57.66	$78.51	$126.24
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.55 / $18.85 / $29.81	Professional	26	$13.55	$18.85	$29.81
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.65 / $63.55 / $102.00	Professional	TC	$48.65	$63.55	$102.00
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.59 / $73.43 / $131.60	Professional		$45.59	$73.43	$131.60
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.99 / $18.98 / $30.76	Professional	26	$9.99	$18.98	$30.76
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.61 / $56.27 / $100.84	Professional	TC	$35.61	$56.27	$100.84
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $64.42 / $64.42 / $68.00	Professional		$64.42	$64.42	$68.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.11 / $80.34 / $149.29	Professional		$64.11	$80.34	$149.29
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.84 / $20.49 / $30.17	Professional	26	$16.84	$20.49	$30.17
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $16.57 / $16.57 / $16.57	Facility	26	$16.57	$16.57	$16.57
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $52.69 / $86.64 / $192.47	Professional		$52.69	$86.64	$192.47
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $12.20 / $21.34 / $45.31	Professional	26	$12.20	$21.34	$45.31
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $36.65 / $59.60 / $151.61	Professional	TC	$36.65	$59.60	$151.61
United Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $63.47 / $130.16	Professional		$50.00	$63.47	$130.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.92 / $15.52 / $33.00	Professional	26	$11.92	$15.52	$33.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.04 / $48.69 / $94.00	Professional	TC	$38.04	$48.69	$94.00
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $16.88 / $16.88 / $58.44	Facility	26	$16.88	$16.88	$58.44
Univera Facility/Professional Professional Modifier Low / Median / High Price $45.59 / $91.15 / $163.18	Professional		$45.59	$91.15	$163.18
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $9.99 / $21.53 / $38.64	Professional	26	$9.99	$21.53	$38.64
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $35.61 / $69.62 / $126.06	Professional	TC	$35.61	$69.62	$126.06