Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.26 / $43.67 / $102.40	Facility	26	$26.26	$43.67	$102.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.50 / $123.53 / $317.91	Professional		$87.50	$123.53	$317.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.27 / $39.44 / $91.56	Professional	26	$26.27	$39.44	$91.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.23 / $83.62 / $166.54	Professional	TC	$61.23	$83.62	$166.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.55 / $121.55 / $121.55	Professional		$121.55	$121.55	$121.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.20 / $28.14 / $29.52	Professional	26	$21.20	$28.14	$29.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.05 / $120.53 / $285.36	Professional		$95.05	$120.53	$285.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.18 / $35.54 / $78.44	Professional	26	$27.18	$35.54	$78.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.87 / $84.28 / $190.64	Professional	TC	$67.87	$84.28	$190.64
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $55.35 / $121.17 / $176.52	Professional		$55.35	$121.17	$176.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.13 / $163.22 / $440.92	Professional		$94.13	$163.22	$440.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.97 / $49.56 / $112.86	Professional	26	$26.97	$49.56	$112.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.72 / $110.70 / $310.10	Professional	TC	$64.72	$110.70	$310.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $110.19 / $141.44 / $246.60	Professional		$110.19	$141.44	$246.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.03 / $49.60 / $79.27	Professional	26	$36.03	$49.60	$79.27
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.34 / $110.29 / $176.58	Professional	TC	$84.34	$110.29	$176.58
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.77 / $144.25 / $258.52	Professional		$75.77	$144.25	$258.52
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.88 / $50.45 / $81.06	Professional	26	$18.88	$50.45	$81.06
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.89 / $99.02 / $177.47	Professional	TC	$56.89	$99.02	$177.47
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $120.07 / $120.07 / $120.07	Professional		$120.07	$120.07	$120.07
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $42.51 / $42.51 / $42.51	Professional	26	$42.51	$42.51	$42.51
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $119.81 / $125.21 / $126.59	Professional		$119.81	$125.21	$126.59
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.00 / $42.52 / $81.20	Professional	26	$39.00	$42.52	$81.20
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $43.57 / $43.57	Facility	26	$43.57	$43.57	$43.57
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $98.71 / $164.74 / $382.55	Professional		$98.71	$164.74	$382.55
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $27.04 / $49.69 / $111.71	Professional	26	$27.04	$49.69	$111.71
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $66.95 / $105.62 / $272.20	Professional	TC	$66.95	$105.62	$272.20
United Facility/Professional Professional Modifier Low / Median / High Price $91.74 / $122.50 / $261.95	Professional		$91.74	$122.50	$261.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.82 / $40.39 / $92.44	Professional	26	$29.82	$40.39	$92.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.16 / $84.32 / $171.71	Professional	TC	$64.16	$84.32	$171.71
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $44.49 / $44.49 / $111.30	Facility	26	$44.49	$44.49	$111.30
Univera Facility/Professional Professional Modifier Low / Median / High Price $75.77 / $178.06 / $311.57	Professional		$75.77	$178.06	$311.57
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $18.88 / $57.24 / $102.72	Professional	26	$18.88	$57.24	$102.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $56.89 / $120.82 / $213.87	Professional	TC	$56.89	$120.82	$213.87