Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.01 / $101.31 / $222.16	Facility	26	$87.01	$101.31	$222.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.01 / $227.83 / $520.49	Professional		$180.01	$227.83	$520.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.87 / $91.97 / $239.34	Professional	26	$72.87	$91.97	$239.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.65 / $129.34 / $290.61	Professional	TC	$105.65	$129.34	$290.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $122.54 / $140.04 / $185.14	Professional		$122.54	$140.04	$185.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.76 / $73.47 / $134.75	Professional	26	$60.76	$73.47	$134.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.90 / $230.65 / $542.58	Professional		$181.90	$230.65	$542.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.90 / $94.25 / $195.95	Professional	26	$75.90	$94.25	$195.95
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.00 / $131.63 / $311.58	Professional	TC	$106.00	$131.63	$311.58
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $120.45 / $156.97 / $277.43	Professional		$120.45	$156.97	$277.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.77 / $314.20 / $871.55	Professional		$149.77	$314.20	$871.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.49 / $115.53 / $254.09	Professional	26	$62.49	$115.53	$254.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.28 / $188.28 / $477.07	Professional	TC	$87.28	$188.28	$477.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $187.27 / $256.74 / $382.27	Professional		$187.27	$256.74	$382.27
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.52 / $107.98 / $170.54	Professional	26	$77.52	$107.98	$170.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $106.82 / $139.56 / $223.88	Professional	TC	$106.82	$139.56	$223.88
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.01 / $214.74 / $390.44	Professional		$153.01	$214.74	$390.44
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.60 / $118.60 / $172.18	Professional	26	$62.60	$118.60	$172.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.53 / $132.19 / $218.26	Professional	TC	$85.53	$132.19	$218.26
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $188.66 / $199.14 / $344.98	Professional		$188.66	$199.14	$344.98
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $60.93 / $60.93 / $68.91	Professional	26	$60.93	$60.93	$68.91
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $98.35 / $98.35 / $98.35	Professional	TC	$98.35	$98.35	$98.35
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.30 / $243.27 / $452.26	Professional		$204.30	$243.27	$452.26
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $90.94 / $110.00 / $199.74	Professional	26	$90.94	$110.00	$199.74
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $145.62 / $145.62 / $145.62	Professional	TC	$145.62	$145.62	$145.62
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $180.16 / $300.00 / $698.69	Professional		$180.16	$300.00	$698.69
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $64.28 / $113.23 / $245.21	Professional	26	$64.28	$113.23	$245.21
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $88.59 / $158.88 / $384.86	Professional	TC	$88.59	$158.88	$384.86
United Facility/Professional Professional Modifier Low / Median / High Price $166.72 / $214.98 / $477.30	Professional		$166.72	$214.98	$477.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.48 / $89.68 / $201.68	Professional	26	$70.48	$89.68	$201.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.79 / $135.59 / $324.80	Professional	TC	$94.79	$135.59	$324.80
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $96.05 / $96.05 / $187.13	Facility	26	$96.05	$96.05	$187.13
Univera Facility/Professional Professional Modifier Low / Median / High Price $165.20 / $286.61 / $478.36	Professional		$165.20	$286.61	$478.36
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $62.60 / $126.39 / $210.95	Professional	26	$62.60	$126.39	$210.95
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $102.59 / $160.22 / $285.81	Professional	TC	$102.59	$160.22	$285.81