Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.33 / $24.85 / $54.41	Facility	26	$15.33	$24.85	$54.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.61 / $89.48 / $195.56	Professional		$62.61	$89.48	$195.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $20.39 / $44.60	Professional	26	$15.33	$20.39	$44.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.28 / $66.19 / $147.28	Professional	TC	$47.28	$66.19	$147.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.01 / $77.01 / $77.01	Professional		$77.01	$77.01	$77.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.34 / $99.34 / $223.18	Professional		$78.34	$99.34	$223.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.12 / $19.77 / $45.55	Professional	26	$15.12	$19.77	$45.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.22 / $78.51 / $158.34	Professional	TC	$63.22	$78.51	$158.34
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $28.89 / $107.80 / $136.69	Professional		$28.89	$107.80	$136.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.83 / $124.89 / $284.38	Professional		$73.83	$124.89	$284.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $27.56 / $60.15	Professional	26	$14.69	$27.56	$60.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.46 / $99.57 / $237.86	Professional	TC	$58.46	$99.57	$237.86
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $89.81 / $116.09 / $200.09	Professional		$89.81	$116.09	$200.09
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $26.13 / $41.69	Professional	26	$19.73	$26.13	$41.69
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.97 / $104.40 / $167.77	Professional	TC	$79.97	$104.40	$167.77
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $115.54 / $207.08	Professional		$68.73	$115.54	$207.08
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $26.54 / $42.31	Professional	26	$16.39	$26.54	$42.31
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.52 / $91.94 / $164.77	Professional	TC	$51.52	$91.94	$164.77
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $102.28 / $102.28 / $107.96	Professional		$102.28	$102.28	$107.96
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.33 / $93.85 / $94.88	Professional		$91.33	$93.85	$94.88
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.07 / $22.89 / $23.14	Professional	26	$21.07	$22.89	$23.14
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $71.40 / $122.88 / $268.97	Professional		$71.40	$122.88	$268.97
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $15.21 / $26.96 / $58.72	Professional	26	$15.21	$26.96	$58.72
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $59.85 / $95.74 / $211.64	Professional	TC	$59.85	$95.74	$211.64
United Facility/Professional Professional Modifier Low / Median / High Price $74.54 / $94.55 / $202.01	Professional		$74.54	$94.55	$202.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.84 / $21.29 / $47.75	Professional	26	$16.84	$21.29	$47.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.52 / $74.02 / $170.62	Professional	TC	$57.52	$74.02	$170.62
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $23.22 / $23.22 / $36.70	Facility	26	$23.22	$23.22	$36.70
Univera Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $144.47 / $249.56	Professional		$68.73	$144.47	$249.56
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $30.11 / $50.99	Professional	26	$17.23	$30.11	$50.99
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $51.52 / $114.37 / $198.57	Professional	TC	$51.52	$114.37	$198.57