Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.26 / $217.07 / $937.72	Facility		$101.26	$217.07	$937.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.19 / $29.44 / $63.46	Facility	26	$21.19	$29.44	$63.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.02 / $131.79 / $454.48	Professional		$93.02	$131.79	$454.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.19 / $35.79 / $100.25	Professional	26	$21.19	$35.79	$100.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.40 / $57.07 / $118.22	Professional	52	$45.40	$57.07	$118.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.59 / $94.28 / $230.68	Professional	TC	$69.59	$94.28	$230.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.73 / $84.72 / $104.64	Professional		$79.73	$84.72	$104.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.66 / $21.29 / $38.15	Professional	26	$18.66	$21.29	$38.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.93 / $132.80 / $297.08	Professional		$106.93	$132.80	$297.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.81 / $30.81 / $61.64	Professional	26	$24.81	$30.81	$61.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.12 / $101.98 / $214.41	Professional	TC	$82.12	$101.98	$214.41
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $39.53 / $39.53 / $124.51	Facility		$39.53	$39.53	$124.51
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $39.53 / $124.51 / $164.04	Professional		$39.53	$124.51	$164.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.02 / $293.74 / $755.52	Facility		$154.02	$293.74	$755.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.47 / $30.47 / $30.47	Facility	26	$30.47	$30.47	$30.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.40 / $159.79 / $359.77	Professional		$91.40	$159.79	$359.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.65 / $38.57 / $82.27	Professional	26	$20.65	$38.57	$82.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.38 / $126.10 / $277.50	Professional	TC	$68.38	$126.10	$277.50
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $70.09 / $125.38 / $332.00	Facility		$70.09	$125.38	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $102.16 / $137.56 / $218.01	Professional		$102.16	$137.56	$218.01
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.27 / $34.86 / $55.59	Professional	26	$25.27	$34.86	$55.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.05 / $110.19 / $193.56	Professional	TC	$87.05	$110.19	$193.56
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $30.30 / $30.30 / $30.30	Facility		$30.30	$30.30	$30.30
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.38 / $129.46 / $232.02	Professional		$80.38	$129.46	$232.02
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.18 / $35.38 / $56.65	Professional	26	$15.18	$35.38	$56.65
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.20 / $97.85 / $175.38	Professional	TC	$65.20	$97.85	$175.38
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $82.10 / $116.54 / $134.94	Professional		$82.10	$116.54	$134.94
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $25.94 / $31.71	Professional	26	$20.30	$25.94	$31.71
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $108.48 / $180.91 / $675.00	Facility		$108.48	$180.91	$675.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.39 / $129.10 / $262.88	Professional		$111.39	$129.10	$262.88
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.82 / $31.93 / $54.94	Professional	26	$29.82	$31.93	$54.94
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.16 / $96.16 / $227.01	Professional	TC	$96.16	$96.16	$227.01
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $123.40 / $293.74 / $597.00	Facility		$123.40	$293.74	$597.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $30.47 / $30.47 / $30.47	Facility	26	$30.47	$30.47	$30.47
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $102.02 / $159.63 / $359.77	Professional		$102.02	$159.63	$359.77
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $22.37 / $38.03 / $81.72	Professional	26	$22.37	$38.03	$81.72
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $74.02 / $119.78 / $272.30	Professional	TC	$74.02	$119.78	$272.30
United Facility/Professional Professional Modifier Low / Median / High Price $82.29 / $117.23 / $256.22	Professional		$82.29	$117.23	$256.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.50 / $28.87 / $68.11	Professional	26	$21.50	$28.87	$68.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.63 / $90.65 / $196.03	Professional	TC	$65.63	$90.65	$196.03
Univera Facility/Professional Facility Modifier Low / Median / High Price $127.32 / $127.32 / $288.20	Facility		$127.32	$127.32	$288.20
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $31.08 / $31.08 / $89.21	Facility	26	$31.08	$31.08	$89.21
Univera Facility/Professional Professional Modifier Low / Median / High Price $80.38 / $147.13 / $287.70	Professional		$80.38	$147.13	$287.70
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $15.18 / $35.92 / $72.72	Professional	26	$15.18	$35.92	$72.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $65.20 / $111.21 / $211.35	Professional	TC	$65.20	$111.21	$211.35