Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $68.47 / $192.50	Facility	26	$55.00	$68.47	$192.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $127.45 / $201.50 / $367.83	Professional		$127.45	$201.50	$367.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.96 / $62.48 / $117.44	Professional	26	$45.96	$62.48	$117.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.48 / $126.02 / $294.26	Professional	TC	$81.48	$126.02	$294.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.31 / $95.31 / $131.05	Professional		$95.31	$95.31	$131.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.86 / $37.86 / $37.86	Professional	26	$37.86	$37.86	$37.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $115.72 / $144.16 / $347.37	Professional		$115.72	$144.16	$347.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.63 / $50.88 / $103.38	Professional	26	$40.63	$50.88	$103.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.08 / $93.24 / $224.63	Professional	TC	$75.08	$93.24	$224.63
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $63.57 / $110.67 / $174.24	Professional		$63.57	$110.67	$174.24
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $122.76 / $165.65 / $249.03	Professional		$122.76	$165.65	$249.03
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.87 / $59.50 / $94.31	Professional	26	$42.87	$59.50	$94.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.17 / $102.82 / $179.71	Professional	TC	$74.17	$102.82	$179.71
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.34 / $156.81 / $227.99	Professional		$100.34	$156.81	$227.99
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.96 / $45.33 / $88.10	Professional	26	$27.96	$45.33	$88.10
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.88 / $111.37 / $139.90	Professional	TC	$65.88	$111.37	$139.90
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $78.90 / $78.90 / $78.90	Professional		$78.90	$78.90	$78.90
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $42.87 / $54.07 / $61.44	Professional	26	$42.87	$54.07	$61.44
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $95.31 / $95.31 / $95.31	Professional	TC	$95.31	$95.31	$95.31
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.33 / $131.66 / $137.19	Professional		$123.33	$131.66	$137.19
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.72 / $50.18 / $108.40	Professional	26	$45.72	$50.18	$108.40
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.35 / $82.35 / $82.35	Professional	TC	$82.35	$82.35	$82.35
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $140.61 / $175.96 / $436.21	Professional		$140.61	$175.96	$436.21
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $48.64 / $59.60 / $91.33	Professional	26	$48.64	$59.60	$91.33
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $81.70 / $102.32 / $157.91	Professional	TC	$81.70	$102.32	$157.91
United Facility/Professional Professional Modifier Low / Median / High Price $102.58 / $147.94 / $282.54	Professional		$102.58	$147.94	$282.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.38 / $49.67 / $100.87	Professional	26	$36.38	$49.67	$100.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.87 / $93.11 / $219.69	Professional	TC	$62.87	$93.11	$219.69
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $47.92 / $47.92 / $120.00	Facility	26	$47.92	$47.92	$120.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $110.95 / $181.51 / $343.87	Professional		$110.95	$181.51	$343.87
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $27.96 / $68.73 / $114.72	Professional	26	$27.96	$68.73	$114.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $68.08 / $121.18 / $214.21	Professional	TC	$68.08	$121.18	$214.21