Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.30 / $171.03 / $649.02	Facility		$79.30	$171.03	$649.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.21 / $31.34 / $65.84	Facility	26	$22.21	$31.34	$65.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $65.68 / $194.20 / $568.97	Facility	TC	$65.68	$194.20	$568.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.18 / $107.68 / $386.36	Professional		$71.18	$107.68	$386.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.60 / $36.33 / $109.72	Professional	26	$22.60	$36.33	$109.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.96 / $71.45 / $153.44	Professional	TC	$48.96	$71.45	$153.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $56.62 / $67.45 / $156.10	Professional		$56.62	$67.45	$156.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.51 / $23.67 / $54.12	Professional	26	$20.51	$23.67	$54.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $106.05 / $106.05 / $106.05	Professional	TC	$106.05	$106.05	$106.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $78.03 / $99.83 / $257.36	Professional		$78.03	$99.83	$257.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.96 / $30.60 / $64.59	Professional	26	$23.96	$30.60	$64.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.07 / $68.55 / $171.13	Professional	TC	$54.07	$68.55	$171.13
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $41.03 / $41.03 / $87.27	Facility		$41.03	$41.03	$87.27
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $41.03 / $87.27 / $128.30	Professional		$41.03	$87.27	$128.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.00 / $206.35 / $584.79	Facility		$144.00	$206.35	$584.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.67 / $126.71 / $328.06	Professional		$69.67	$126.71	$328.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.63 / $39.93 / $84.98	Professional	26	$21.63	$39.93	$84.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.80 / $88.16 / $228.93	Professional	TC	$47.80	$88.16	$228.93
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $50.01 / $89.53 / $332.00	Facility		$50.01	$89.53	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $80.50 / $118.12 / $177.10	Professional		$80.50	$118.12	$177.10
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $36.09 / $57.73	Professional	26	$26.24	$36.09	$57.73
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.04 / $78.68 / $119.37	Professional	TC	$62.04	$78.68	$119.37
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $40.40 / $40.40 / $40.40	Facility		$40.40	$40.40	$40.40
Excellus BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $24.24 / $24.24 / $24.24	Facility	TC	$24.24	$24.24	$24.24
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.69 / $102.32 / $183.38	Professional		$70.69	$102.32	$183.38
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $36.74 / $58.85	Professional	26	$15.92	$36.74	$58.85
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.00 / $73.03 / $124.53	Professional	TC	$48.00	$73.03	$124.53
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $87.09 / $93.45	Professional		$35.95	$87.09	$93.45
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $21.02 / $23.77 / $29.00	Professional	26	$21.02	$23.77	$29.00
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $74.72 / $169.04 / $771.52	Facility		$74.72	$169.04	$771.52
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $70.95 / $173.81 / $622.72	Facility	TC	$70.95	$173.81	$622.72
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.02 / $101.67 / $120.73	Professional		$92.02	$101.67	$120.73
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.81 / $39.70 / $67.81	Professional	26	$32.81	$39.70	$67.81
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $62.09 / $62.09 / $66.65	Professional	TC	$62.09	$62.09	$66.65
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $105.94 / $206.35 / $597.00	Facility		$105.94	$206.35	$597.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $31.67 / $31.67 / $31.67	Facility	26	$31.67	$31.67	$31.67
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $66.73 / $66.73 / $66.73	Facility	TC	$66.73	$66.73	$66.73
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $87.25 / $126.25 / $290.89	Professional		$87.25	$126.25	$290.89
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $23.11 / $39.47 / $84.92	Professional	26	$23.11	$39.47	$84.92
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $54.72 / $83.85 / $198.72	Professional	TC	$54.72	$83.85	$198.72
United Facility/Professional Professional Modifier Low / Median / High Price $71.14 / $92.40 / $198.81	Professional		$71.14	$92.40	$198.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.41 / $29.95 / $69.91	Professional	26	$22.41	$29.95	$69.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.63 / $65.56 / $152.05	Professional	TC	$48.63	$65.56	$152.05
Univera Facility/Professional Facility Modifier Low / Median / High Price $100.63 / $100.63 / $258.66	Facility		$100.63	$100.63	$258.66
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $32.29 / $32.29 / $94.80	Facility	26	$32.29	$32.29	$94.80
Univera Facility/Professional Facility Modifier TC Low / Median / High Price $68.33 / $68.33 / $192.95	Facility	TC	$68.33	$68.33	$192.95
Univera Facility/Professional Professional Modifier Low / Median / High Price $72.45 / $116.28 / $227.38	Professional		$72.45	$116.28	$227.38
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $37.32 / $75.48	Professional	26	$15.92	$37.32	$75.48
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $56.53 / $78.95 / $158.51	Professional	TC	$56.53	$78.95	$158.51