Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.25 / $16.96 / $41.03	Facility	26	$12.25	$16.96	$41.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.38 / $73.29 / $196.07	Professional		$48.38	$73.29	$196.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.25 / $16.00 / $41.03	Professional	26	$12.25	$16.00	$41.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.13 / $50.05 / $104.21	Professional	TC	$36.13	$50.05	$104.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.69 / $48.22 / $75.51	Professional		$45.69	$48.22	$75.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.43 / $11.09 / $21.48	Professional	26	$8.43	$11.09	$21.48
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.98 / $71.56 / $169.53	Professional		$55.98	$71.56	$169.53
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.49 / $15.02 / $35.69	Professional	26	$11.49	$15.02	$35.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.49 / $55.25 / $114.98	Professional	TC	$44.49	$55.25	$114.98
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $21.60 / $76.29 / $97.89	Professional		$21.60	$76.29	$97.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.89 / $93.35 / $219.87	Professional		$52.89	$93.35	$219.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $21.45 / $46.11	Professional	26	$11.32	$21.45	$46.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.22 / $72.84 / $170.61	Professional	TC	$41.22	$72.84	$170.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $65.06 / $84.30 / $143.15	Professional		$65.06	$84.30	$143.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.18 / $19.72 / $31.20	Professional	26	$14.18	$19.72	$31.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.47 / $73.79 / $118.33	Professional	TC	$56.47	$73.79	$118.33
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.32 / $82.39 / $147.66	Professional		$53.32	$82.39	$147.66
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $19.86 / $32.19	Professional	26	$12.96	$19.86	$32.19
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.34 / $64.43 / $115.47	Professional	TC	$39.34	$64.43	$115.47
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $76.48 / $76.48 / $77.18	Professional		$76.48	$76.48	$77.18
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $17.91 / $17.91 / $17.91	Professional	26	$17.91	$17.91	$17.91
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.31 / $91.10 / $104.45	Professional		$68.31	$91.10	$104.45
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.76 / $18.07 / $32.45	Professional	26	$15.76	$18.07	$32.45
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $17.32 / $17.32 / $17.32	Facility	26	$17.32	$17.32	$17.32
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $54.41 / $92.06 / $201.81	Professional		$54.41	$92.06	$201.81
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $11.98 / $21.12 / $45.29	Professional	26	$11.98	$21.12	$45.29
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $42.08 / $69.36 / $151.97	Professional	TC	$42.08	$69.36	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $55.90 / $68.56 / $158.31	Professional		$55.90	$68.56	$158.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.14 / $16.73 / $35.51	Professional	26	$13.14	$16.73	$35.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.04 / $54.31 / $123.77	Professional	TC	$43.04	$54.31	$123.77
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $17.66 / $17.66 / $28.98	Facility	26	$17.66	$17.66	$28.98
Univera Facility/Professional Professional Modifier Low / Median / High Price $53.32 / $103.37 / $177.95	Professional		$53.32	$103.37	$177.95
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $13.74 / $22.53 / $38.79	Professional	26	$13.74	$22.53	$38.79
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $39.58 / $80.83 / $139.16	Professional	TC	$39.58	$80.83	$139.16