Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.68 / $84.25 / $193.38	Facility	26	$59.68	$84.25	$193.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $121.74 / $194.71 / $763.73	Professional		$121.74	$194.71	$763.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $98.94 / $644.54	Professional	26	$56.92	$98.94	$644.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.06 / $102.94 / $207.32	Professional	TC	$62.06	$102.94	$207.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.98 / $100.98 / $138.84	Professional		$100.98	$100.98	$138.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.74 / $50.74 / $50.74	Professional	26	$50.74	$50.74	$50.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.68 / $139.46 / $370.70	Professional		$106.68	$139.46	$370.70
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.56 / $64.79 / $148.38	Professional	26	$49.56	$64.79	$148.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.12 / $74.67 / $217.99	Professional	TC	$57.12	$74.67	$217.99
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $85.26 / $92.05 / $177.30	Professional		$85.26	$92.05	$177.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	26	$68.78	$68.78	$68.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.18 / $203.14 / $405.57	Professional		$112.18	$203.14	$405.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.12 / $84.94 / $192.04	Professional	26	$52.12	$84.94	$192.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.06 / $114.72 / $236.46	Professional	TC	$60.06	$114.72	$236.46
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $123.31 / $174.76 / $260.02	Professional		$123.31	$174.76	$260.02
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.13 / $79.18 / $126.46	Professional	26	$57.13	$79.18	$126.46
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.18 / $91.74 / $160.35	Professional	TC	$66.18	$91.74	$160.35
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.98 / $128.38 / $234.60	Professional		$79.98	$128.38	$234.60
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.99 / $61.38 / $116.98	Professional	26	$41.99	$61.38	$116.98
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $48.00 / $82.19 / $120.91	Professional	TC	$48.00	$82.19	$120.91
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $128.22 / $128.22 / $130.01	Professional		$128.22	$128.22	$130.01
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.19 / $142.05 / $143.61	Professional		$118.19	$142.05	$143.61
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.72 / $91.30 / $146.16	Professional	26	$66.72	$91.30	$146.16
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	26	$68.78	$68.78	$68.78
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $136.82 / $223.90 / $421.08	Professional		$136.82	$223.90	$421.08
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $59.07 / $85.63 / $192.04	Professional	26	$59.07	$85.63	$192.04
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $66.77 / $105.25 / $235.12	Professional	TC	$66.77	$105.25	$235.12
United Facility/Professional Professional Modifier Low / Median / High Price $107.59 / $153.66 / $307.30	Professional		$107.59	$153.66	$307.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.95 / $68.59 / $150.11	Professional	26	$49.95	$68.59	$150.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.65 / $86.60 / $184.07	Professional	TC	$57.65	$86.60	$184.07
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $64.88 / $64.88 / $199.02	Facility	26	$64.88	$64.88	$199.02
Univera Facility/Professional Professional Modifier Low / Median / High Price $118.19 / $163.86 / $362.26	Professional		$118.19	$163.86	$362.26
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $41.99 / $79.41 / $175.56	Professional	26	$41.99	$79.41	$175.56
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $60.71 / $86.39 / $186.70	Professional	TC	$60.71	$86.39	$186.70