Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $92.61 / $198.95 / $929.68	Facility		$92.61	$198.95	$929.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.80 / $38.06 / $94.37	Facility	26	$27.80	$38.06	$94.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $78.84 / $213.59 / $691.90	Facility	TC	$78.84	$213.59	$691.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.20 / $137.52 / $519.69	Professional		$88.20	$137.52	$519.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $39.85 / $128.80	Professional	26	$27.80	$39.85	$128.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.10 / $55.53 / $96.84	Professional	52	$44.10	$55.53	$96.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.39 / $87.95 / $190.46	Professional	TC	$60.39	$87.95	$190.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.49 / $96.10 / $194.00	Professional		$63.49	$96.10	$194.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.74 / $27.70 / $49.68	Professional	26	$25.74	$27.70	$49.68
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.19 / $125.74 / $315.18	Professional		$96.19	$125.74	$315.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.28 / $38.28 / $81.39	Professional	26	$29.28	$38.28	$81.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.90 / $84.83 / $214.04	Professional	TC	$66.90	$84.83	$214.04
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $50.91 / $50.91 / $107.80	Facility		$50.91	$50.91	$107.80
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $50.91 / $107.80 / $158.72	Professional		$50.91	$107.80	$158.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $150.88 / $254.52 / $743.93	Facility		$150.88	$254.52	$743.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.77 / $157.16 / $404.29	Professional		$86.77	$157.16	$404.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.18 / $49.22 / $106.22	Professional	26	$27.18	$49.22	$106.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.01 / $109.75 / $282.52	Professional	TC	$61.01	$109.75	$282.52
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $61.93 / $110.70 / $332.00	Facility		$61.93	$110.70	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $105.17 / $145.90 / $219.89	Professional		$105.17	$145.90	$219.89
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $45.29 / $72.29	Professional	26	$32.86	$45.29	$72.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.92 / $97.28 / $177.78	Professional	TC	$76.92	$97.28	$177.78
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 Facility Modifier TC Low / Median / High Price $36.36 / $36.36 / $36.36	Facility	TC	$36.36	$36.36	$36.36
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $88.03 / $127.42 / $228.36	Professional		$88.03	$127.42	$228.36
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $46.01 / $74.58	Professional	26	$19.98	$46.01	$74.58
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.28 / $88.50 / $153.78	Professional	TC	$59.28	$88.50	$153.78
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $94.95 / $110.03 / $123.42	Professional		$94.95	$110.03	$123.42
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $25.89 / $33.69 / $44.93	Professional	26	$25.89	$33.69	$44.93
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $72.03 / $72.03 / $72.03	Professional	TC	$72.03	$72.03	$72.03
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $108.48 / $196.46 / $1,012.92	Facility		$108.48	$196.46	$1,012.92
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $83.61 / $190.26 / $774.35	Facility	TC	$83.61	$190.26	$774.35
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.47 / $125.91 / $227.77	Professional		$113.47	$125.91	$227.77
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $41.87 / $83.00	Professional	26	$37.15	$41.87	$83.00
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.17 / $79.17 / $79.17	Professional	TC	$79.17	$79.17	$79.17
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $121.16 / $254.52 / $597.00	Facility		$121.16	$254.52	$597.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $40.13 / $40.13 / $40.13	Facility	26	$40.13	$40.13	$40.13
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $82.40 / $82.40 / $82.40	Facility	TC	$82.40	$82.40	$82.40
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $108.54 / $157.32 / $374.89	Professional		$108.54	$157.32	$374.89
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $28.80 / $49.15 / $103.85	Professional	26	$28.80	$49.15	$103.85
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $67.58 / $103.65 / $251.36	Professional	TC	$67.58	$103.65	$251.36
United Facility/Professional Professional Modifier Low / Median / High Price $89.44 / $118.12 / $280.99	Professional		$89.44	$118.12	$280.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.86 / $36.71 / $81.84	Professional	26	$27.86	$36.71	$81.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.40 / $78.76 / $176.35	Professional	TC	$58.40	$78.76	$176.35
Univera Facility/Professional Facility Modifier Low / Median / High Price $125.31 / $125.31 / $346.87	Facility		$125.31	$125.31	$346.87
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $40.92 / $40.92 / $118.47	Facility	26	$40.92	$40.92	$118.47
Univera Facility/Professional Facility Modifier TC Low / Median / High Price $84.39 / $84.39 / $259.14	Facility	TC	$84.39	$84.39	$259.14
Univera Facility/Professional Professional Modifier Low / Median / High Price $107.94 / $144.81 / $283.16	Professional		$107.94	$144.81	$283.16
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $47.29 / $93.68	Professional	26	$19.98	$47.29	$93.68
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $73.23 / $97.52 / $195.33	Professional	TC	$73.23	$97.52	$195.33