Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $194.98 / $707.95	Facility		$93.33	$194.98	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $38.02 / $93.33	Facility	26	$27.54	$38.02	$93.33
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $79.43 / $223.87 / $707.95	Facility	TC	$79.43	$223.87	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $158.49 / $549.54	Professional		$91.20	$158.49	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $128.82	Professional	26	$30.20	$45.71	$128.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	52	$181.97	$181.97	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $89.13 / $234.42	Professional	TC	$60.26	$89.13	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $93.33 / $177.83	Professional		$79.43	$93.33	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $36.31 / $63.10	Professional	26	$28.84	$36.31	$63.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $120.23 / $281.84	Professional		$95.50	$120.23	$281.84
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $37.15 / $70.79	Professional	26	$29.51	$37.15	$70.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $83.18 / $169.82	Professional	TC	$67.61	$83.18	$169.82
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $51.29 / $107.15	Facility		$51.29	$51.29	$107.15
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $107.15 / $158.49	Professional		$51.29	$107.15	$158.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $229.09 / $794.33	Facility		$154.88	$229.09	$794.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	26	$8.51	$39.81	$56.23
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	TC	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $154.88 / $407.38	Professional		$91.20	$154.88	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $50.12 / $112.20	Professional	26	$28.84	$50.12	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $107.15 / $281.84	Professional	TC	$61.66	$107.15	$281.84
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $95.50 / $257.04	Facility		$61.66	$95.50	$257.04
Emblem Health Facility/Professional Facility Modifier TC Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	TC	$85.11	$85.11	$85.11
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $223.87	Professional		$102.33	$138.04	$223.87
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $51.29 / $114.82	Professional	26	$34.67	$51.29	$114.82
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $100.00 / $158.49	Professional	TC	$75.86	$100.00	$158.49
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Facility		$60.26	$60.26	$60.26
Excellus BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	TC	$36.31	$36.31	$36.31
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $141.25 / $245.47	Professional		$97.72	$141.25	$245.47
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $46.77 / $83.18	Professional	26	$19.95	$46.77	$83.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $93.33 / $165.96	Professional	TC	$66.07	$93.33	$165.96
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $32.36	Professional	26	$25.70	$25.70	$32.36
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $151.36 / $870.96	Facility		$109.65	$151.36	$870.96
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $85.11 / $204.17 / $776.25	Facility	TC	$85.11	$204.17	$776.25
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $125.89 / $223.87	Professional		$114.82	$125.89	$223.87
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $41.69 / $74.13	Professional	26	$41.69	$41.69	$74.13
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $79.43 / $181.97	Professional	TC	$79.43	$79.43	$181.97
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $147.91 / $53,703.18	Facility		$77.62	$147.91	$53,703.18
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $154.88 / $239.88	Professional		$128.82	$154.88	$239.88
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $79.43	Professional	26	$41.69	$51.29	$79.43
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $104.71 / $162.18	Professional	TC	$89.13	$104.71	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $245.47 / $302.00	Facility		$208.93	$245.47	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $112.20 / $245.47	Professional		$83.18	$112.20	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $35.48 / $77.62	Professional	26	$25.12	$35.48	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $77.62 / $169.82	Professional	TC	$56.23	$77.62	$169.82
Univera Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $87.10 / $281.84	Facility		$60.26	$87.10	$281.84
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $40.74 / $117.49	Facility	26	$28.84	$40.74	$117.49
Univera Facility/Professional Facility Modifier TC Low / Median / High Price $36.31 / $58.88 / $223.87	Facility	TC	$36.31	$58.88	$223.87
Univera Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $134.90 / $275.42	Professional		$87.10	$134.90	$275.42
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $45.71 / $102.33	Professional	26	$28.84	$45.71	$102.33
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $91.20 / $208.93	Professional	TC	$58.88	$91.20	$208.93