Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.00 / $52.50 / $125.51	Facility	26	$38.00	$52.50	$125.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.48 / $151.59 / $545.00	Professional		$97.48	$151.59	$545.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.00 / $59.88 / $181.00	Professional	26	$38.00	$59.88	$181.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.60 / $75.66 / $139.31	Professional	TC	$57.60	$75.66	$139.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.22 / $91.18 / $109.74	Professional		$76.22	$91.18	$109.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.52 / $40.79 / $66.66	Professional	26	$32.52	$40.79	$66.66
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.57 / $130.06 / $320.05	Professional		$102.57	$130.06	$320.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.64 / $50.52 / $107.01	Professional	26	$38.64	$50.52	$107.01
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.92 / $79.38 / $188.88	Professional	TC	$63.92	$79.38	$188.88
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $68.66 / $103.03 / $171.69	Professional		$68.66	$103.03	$171.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.40 / $188.84 / $406.49	Professional		$101.40	$188.84	$406.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.85 / $68.02 / $144.01	Professional	26	$36.85	$68.02	$144.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.06 / $104.61 / $270.05	Professional	TC	$56.06	$104.61	$270.05
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $121.74 / $157.19 / $238.50	Professional		$121.74	$157.19	$238.50
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.95 / $60.62 / $97.53	Professional	26	$45.95	$60.62	$97.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.22 / $92.93 / $141.00	Professional	TC	$73.22	$92.93	$141.00
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.64 / $148.50 / $248.10	Professional		$95.64	$148.50	$248.10
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.71 / $62.06 / $99.89	Professional	26	$39.71	$62.06	$99.89
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.13 / $93.98 / $148.21	Professional	TC	$57.13	$93.98	$148.21
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $111.13 / $125.68 / $215.60	Professional		$111.13	$125.68	$215.60
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $45.18 / $53.21 / $109.58	Professional	26	$45.18	$53.21	$109.58
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.32 / $137.85 / $279.41	Professional		$135.32	$137.85	$279.41
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.29 / $56.91 / $112.51	Professional	26	$56.29	$56.91	$112.51
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.05 / $80.05 / $80.05	Professional	TC	$80.05	$80.05	$80.05
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $98.96 / $176.74 / $372.84	Professional		$98.96	$176.74	$372.84
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $38.50 / $66.93 / $138.12	Professional	26	$38.50	$66.93	$138.12
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $61.65 / $98.12 / $229.88	Professional	TC	$61.65	$98.12	$229.88
United Facility/Professional Professional Modifier Low / Median / High Price $90.66 / $124.51 / $267.29	Professional		$90.66	$124.51	$267.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.70 / $49.66 / $118.99	Professional	26	$37.70	$49.66	$118.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.65 / $77.61 / $161.30	Professional	TC	$58.65	$77.61	$161.30
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $54.82 / $54.82 / $160.60	Facility	26	$54.82	$54.82	$160.60
Univera Facility/Professional Professional Modifier Low / Median / High Price $118.14 / $157.33 / $313.79	Professional		$118.14	$157.33	$313.79
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $47.57 / $63.34 / $126.35	Professional	26	$47.57	$63.34	$126.35
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $70.56 / $97.38 / $183.78	Professional	TC	$70.56	$97.38	$183.78