Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.43 / $24.26 / $49.90	Facility	26	$14.43	$24.26	$49.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.60 / $104.50 / $221.61	Professional		$54.60	$104.50	$221.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.43 / $18.79 / $49.12	Professional	26	$14.43	$18.79	$49.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.17 / $87.32 / $174.63	Professional	TC	$40.17	$87.32	$174.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.12 / $27.57	Professional	26	$13.18	$16.12	$27.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.06 / $74.83 / $239.08	Professional		$58.06	$74.83	$239.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $12.93 / $42.45	Professional	26	$10.02	$12.93	$42.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.35 / $61.90 / $182.60	Professional	TC	$47.35	$61.90	$182.60
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $26.23 / $117.83 / $144.06	Professional		$26.23	$117.83	$144.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.25 / $134.19 / $315.01	Professional		$75.25	$134.19	$315.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.54 / $25.12 / $55.35	Professional	26	$13.54	$25.12	$55.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.19 / $113.34 / $261.08	Professional	TC	$63.19	$113.34	$261.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $94.15 / $121.40 / $197.12	Professional		$94.15	$121.40	$197.12
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $22.84 / $37.22	Professional	26	$16.92	$22.84	$37.22
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $105.39 / $159.90	Professional	TC	$80.59	$105.39	$159.90
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $115.40 / $196.76	Professional		$77.84	$115.40	$196.76
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $23.69 / $35.86	Professional	26	$10.54	$23.69	$35.86
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.19 / $94.36 / $160.88	Professional	TC	$65.19	$94.36	$160.88
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $94.15 / $100.19 / $100.19	Professional		$94.15	$100.19	$100.19
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.94 / $98.74 / $210.20	Professional		$95.94	$98.74	$210.20
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.97 / $21.41 / $42.94	Professional	26	$19.97	$21.41	$42.94
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $20.50	Facility	26	$20.50	$20.50	$20.50
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $73.20 / $133.80 / $284.56	Professional		$73.20	$133.80	$284.56
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $24.88 / $55.35	Professional	26	$13.80	$24.88	$55.35
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $64.37 / $107.93 / $228.85	Professional	TC	$64.37	$107.93	$228.85
United Facility/Professional Professional Modifier Low / Median / High Price $75.89 / $97.80 / $205.39	Professional		$75.89	$97.80	$205.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $19.13 / $41.47	Professional	26	$14.47	$19.13	$41.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.94 / $82.60 / $176.49	Professional	TC	$62.94	$82.60	$176.49
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $18.98 / $18.98 / $53.56	Facility	26	$18.98	$18.98	$53.56
Univera Facility/Professional Professional Modifier Low / Median / High Price $77.84 / $142.34 / $249.24	Professional		$77.84	$142.34	$249.24
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $26.88 / $45.44	Professional	26	$10.54	$26.88	$45.44
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $67.30 / $115.45 / $203.80	Professional	TC	$67.30	$115.45	$203.80