Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.91 / $201.66 / $826.63	Facility		$97.91	$201.66	$826.63
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.39 / $41.63 / $89.65	Facility	26	$30.39	$41.63	$89.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.26 / $146.01 / $508.62	Professional		$95.26	$146.01	$508.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.40 / $44.02 / $140.26	Professional	26	$30.40	$44.02	$140.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.86 / $93.17 / $205.90	Professional	TC	$64.86	$93.17	$205.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.45 / $89.81 / $113.88	Professional		$75.45	$89.81	$113.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.95 / $30.68 / $62.40	Professional	26	$27.95	$30.68	$62.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $139.06 / $139.06 / $139.06	Professional	TC	$139.06	$139.06	$139.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.64 / $131.43 / $337.10	Professional		$103.64	$131.43	$337.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.96 / $41.74 / $88.40	Professional	26	$31.96	$41.74	$88.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.68 / $90.89 / $218.47	Professional	TC	$71.68	$90.89	$218.47
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $55.85 / $55.85 / $115.92	Facility		$55.85	$55.85	$115.92
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $55.85 / $115.92 / $171.76	Professional		$55.85	$115.92	$171.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.02 / $273.55 / $761.31	Facility		$154.02	$273.55	$761.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.62 / $43.62 / $43.62	Facility	26	$43.62	$43.62	$43.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.21 / $170.05 / $436.88	Professional		$93.21	$170.05	$436.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.59 / $54.85 / $116.19	Professional	26	$29.59	$54.85	$116.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.19 / $121.98 / $303.70	Professional	TC	$63.19	$121.98	$303.70
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $65.59 / $117.28 / $332.00	Facility		$65.59	$117.28	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $108.71 / $156.26 / $235.69	Professional		$108.71	$156.26	$235.69
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.04 / $49.54 / $79.31	Professional	26	$36.04	$49.54	$79.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.45 / $103.07 / $188.26	Professional	TC	$81.45	$103.07	$188.26
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.60 / $60.60 / $60.60	Facility		$60.60	$60.60	$60.60
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $94.51 / $136.80 / $245.18	Professional		$94.51	$136.80	$245.18
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.84 / $50.47 / $81.11	Professional	26	$21.84	$50.47	$81.11
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.25 / $91.55 / $164.07	Professional	TC	$63.25	$91.55	$164.07
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $64.40 / $117.77 / $125.54	Professional		$64.40	$117.77	$125.54
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $26.98 / $36.88 / $45.79	Professional	26	$26.98	$36.88	$45.79
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $108.48 / $188.71 / $1,223.31	Facility		$108.48	$188.71	$1,223.31
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.20 / $149.99 / $241.66	Professional		$123.20	$149.99	$241.66
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.75 / $47.04 / $78.29	Professional	26	$40.75	$47.04	$78.29
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.29 / $89.29 / $89.29	Professional	TC	$89.29	$89.29	$89.29
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $130.11 / $273.55 / $597.00	Facility		$130.11	$273.55	$597.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $43.62 / $43.62 / $43.62	Facility	26	$43.62	$43.62	$43.62
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $169.60 / $402.89	Professional		$120.00	$169.60	$402.89
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $31.31 / $55.01 / $113.76	Professional	26	$31.31	$55.01	$113.76
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $75.79 / $111.44 / $263.39	Professional	TC	$75.79	$111.44	$263.39
United Facility/Professional Professional Modifier Low / Median / High Price $97.74 / $125.23 / $266.19	Professional		$97.74	$125.23	$266.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.24 / $41.11 / $96.83	Professional	26	$31.24	$41.11	$96.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.42 / $83.46 / $183.87	Professional	TC	$63.42	$83.46	$183.87
Univera Facility/Professional Facility Modifier Low / Median / High Price $134.54 / $134.54 / $359.44	Facility		$134.54	$134.54	$359.44
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $44.51 / $44.51 / $131.08	Facility	26	$44.51	$44.51	$131.08
Univera Facility/Professional Professional Modifier Low / Median / High Price $112.03 / $155.47 / $304.02	Professional		$112.03	$155.47	$304.02
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $21.84 / $51.43 / $102.76	Professional	26	$21.84	$51.43	$102.76
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $78.13 / $104.04 / $207.61	Professional	TC	$78.13	$104.04	$207.61