Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.23 / $42.92 / $99.78	Facility	26	$30.23	$42.92	$99.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.16 / $99.72 / $358.85	Professional		$69.16	$99.72	$358.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.23 / $40.52 / $117.37	Professional	26	$30.23	$40.52	$117.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $53.34 / $96.70	Professional	TC	$38.90	$53.34	$96.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.37 / $90.08 / $132.38	Professional		$80.37	$90.08	$132.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.06 / $34.29 / $61.06	Professional	26	$24.06	$34.29	$61.06
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.08 / $92.66 / $215.75	Professional		$73.08	$92.66	$215.75
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.94 / $40.04 / $84.48	Professional	26	$30.94	$40.04	$84.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.13 / $53.42 / $126.96	Professional	TC	$42.13	$53.42	$126.96
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $53.85 / $68.17 / $122.02	Professional		$53.85	$68.17	$122.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.31 / $134.35 / $290.02	Professional		$71.31	$134.35	$290.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.53 / $52.99 / $114.22	Professional	26	$28.53	$52.99	$114.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.38 / $74.25 / $179.08	Professional	TC	$40.38	$74.25	$179.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $90.66 / $115.80 / $175.74	Professional		$90.66	$115.80	$175.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $46.43 / $75.42	Professional	26	$35.11	$46.43	$75.42
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.47 / $66.12 / $100.86	Professional	TC	$52.47	$66.12	$100.86
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.87 / $109.52 / $181.26	Professional		$69.87	$109.52	$181.26
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.18 / $48.00 / $77.79	Professional	26	$31.18	$48.00	$77.79
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.89 / $65.92 / $103.47	Professional	TC	$39.89	$65.92	$103.47
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $85.47 / $99.13 / $158.66	Professional		$85.47	$99.13	$158.66
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $34.81 / $42.38 / $86.47	Professional	26	$34.81	$42.38	$86.47
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $75.79 / $75.79 / $75.79	Professional	TC	$75.79	$75.79	$75.79
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.82 / $111.84 / $171.10	Professional		$97.82	$111.84	$171.10
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.32 / $44.81 / $88.57	Professional	26	$44.32	$44.81	$88.57
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.88 / $54.88 / $55.48	Professional	TC	$54.88	$54.88	$55.48
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $83.14 / $125.30 / $269.99	Professional		$83.14	$125.30	$269.99
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $30.21 / $52.14 / $109.74	Professional	26	$30.21	$52.14	$109.74
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $44.33 / $65.89 / $154.63	Professional	TC	$44.33	$65.89	$154.63
United Facility/Professional Professional Modifier Low / Median / High Price $68.16 / $93.62 / $201.39	Professional		$68.16	$93.62	$201.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.18 / $38.63 / $85.97	Professional	26	$29.18	$38.63	$85.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.50 / $55.95 / $108.06	Professional	TC	$39.50	$55.95	$108.06
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $42.69 / $42.69 / $124.56	Facility	26	$42.69	$42.69	$124.56
Univera Facility/Professional Professional Modifier Low / Median / High Price $86.31 / $114.94 / $223.78	Professional		$86.31	$114.94	$223.78
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $37.04 / $49.33 / $97.71	Professional	26	$37.04	$49.33	$97.71
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $49.27 / $69.19 / $126.06	Professional	TC	$49.27	$69.19	$126.06