Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.46 / $69.56 / $100.96	Facility		$41.46	$69.56	$100.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.00 / $22.00 / $40.65	Facility	26	$22.00	$22.00	$40.65
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.26 / $59.96 / $103.26	Facility	TC	$30.26	$59.96	$103.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $59.35 / $126.15	Professional		$45.00	$59.35	$126.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.30 / $32.47 / $90.81	Professional	26	$17.30	$32.47	$90.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.69 / $38.14 / $94.34	Professional	TC	$27.69	$38.14	$94.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.61 / $29.26 / $31.54	Professional	26	$12.61	$29.26	$31.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.98 / $79.51 / $208.50	Professional		$40.98	$79.51	$208.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.46 / $32.04 / $95.18	Professional	26	$22.46	$32.04	$95.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.52 / $47.55 / $109.71	Professional	TC	$18.52	$47.55	$109.71
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $16.48 / $39.35 / $54.33	Facility		$16.48	$39.35	$54.33
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $27.68 / $47.73 / $93.68	Professional		$27.68	$47.73	$93.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $81.40 / $98.07 / $173.88	Facility		$81.40	$98.07	$173.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.18 / $97.18 / $97.18	Facility	26	$97.18	$97.18	$97.18
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $76.69 / $76.69 / $76.69	Facility	TC	$76.69	$76.69	$76.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.72 / $84.62 / $209.05	Professional		$39.72	$84.62	$209.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.03 / $35.40 / $106.08	Professional	26	$16.03	$35.40	$106.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.15 / $48.63 / $111.70	Professional	TC	$24.15	$48.63	$111.70
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $11.60 / $11.60 / $11.60	Facility		$11.60	$11.60	$11.60
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.63 / $64.62 / $129.81	Professional		$42.63	$64.62	$129.81
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.30 / $27.59 / $73.56	Professional	26	$19.30	$27.59	$73.56
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.21 / $39.82 / $71.61	Professional	TC	$26.21	$39.82	$71.61
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.46 / $83.00 / $143.88	Professional		$55.46	$83.00	$143.88
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.23 / $33.53 / $57.66	Professional	26	$22.23	$33.53	$57.66
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.22 / $50.30 / $86.21	Professional	TC	$33.22	$50.30	$86.21
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $29.11 / $30.57 / $68.66	Professional		$29.11	$30.57	$68.66
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $26.76 / $37.25	Professional	26	$26.76	$26.76	$37.25
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $21.54 / $21.54 / $27.65	Professional	TC	$21.54	$21.54	$27.65
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.58 / $43.58 / $43.58	Professional		$43.58	$43.58	$43.58
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $18.13 / $21.77 / $56.19	Professional	26	$18.13	$21.77	$56.19
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $98.07 / $98.07 / $173.88	Facility		$98.07	$98.07	$173.88
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $97.18 / $97.18 / $97.18	Facility	26	$97.18	$97.18	$97.18
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $76.69 / $76.69 / $76.69	Facility	TC	$76.69	$76.69	$76.69
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $80.31 / $209.05	Professional		$39.97	$80.31	$209.05
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $15.47 / $31.30 / $101.50	Professional	26	$15.47	$31.30	$101.50
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.79 / $106.98	Professional	TC	$23.99	$39.79	$106.98
United Facility/Professional Professional Modifier Low / Median / High Price $35.83 / $55.85 / $122.56	Professional		$35.83	$55.85	$122.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.24 / $21.15 / $50.14	Professional	26	$14.24	$21.15	$50.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.59 / $29.18 / $73.40	Professional	TC	$21.59	$29.18	$73.40
Univera Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $83.00 / $173.39	Professional		$63.10	$83.00	$173.39
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $25.41 / $33.53 / $69.48	Professional	26	$25.41	$33.53	$69.48
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $37.69 / $50.30 / $103.90	Professional	TC	$37.69	$50.30	$103.90