Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.20 / $95.95 / $990.40	Facility		$52.20	$95.95	$990.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.82 / $29.69 / $54.91	Facility	26	$23.82	$29.69	$54.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.31 / $53.86 / $104.40	Facility	TC	$26.31	$53.86	$104.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.39 / $78.30 / $293.89	Professional		$50.39	$78.30	$293.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.23 / $71.16 / $615.60	Professional	26	$28.23	$71.16	$615.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $22.92 / $32.50 / $64.61	Professional	52	$22.92	$32.50	$64.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.31 / $43.61 / $168.12	Professional	TC	$26.31	$43.61	$168.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.58 / $63.53 / $200.93	Professional		$33.58	$63.53	$200.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $34.29 / $42.53	Professional	26	$17.23	$34.29	$42.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	TC	$36.31	$36.31	$36.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.34 / $85.54 / $268.64	Professional		$42.34	$85.54	$268.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.13 / $47.06 / $102.29	Professional	26	$24.13	$47.06	$102.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $38.47 / $115.45	Professional	TC	$18.21	$38.47	$115.45
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $19.35 / $46.21 / $53.15	Facility		$19.35	$46.21	$53.15
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $27.40 / $50.00 / $99.36	Professional		$27.40	$50.00	$99.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.40 / $83.61 / $146.00	Facility		$69.40	$83.61	$146.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.29 / $78.29 / $78.29	Facility	26	$78.29	$78.29	$78.29
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $67.70 / $67.70 / $67.70	Facility	TC	$67.70	$67.70	$67.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.76 / $84.69 / $211.62	Professional		$40.76	$84.69	$211.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $45.77 / $103.40	Professional	26	$20.23	$45.77	$103.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.72 / $44.52 / $129.99	Professional	TC	$19.72	$44.52	$129.99
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $32.00 / $32.00 / $32.00	Facility		$32.00	$32.00	$32.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $44.97 / $75.56 / $136.28	Professional		$44.97	$75.56	$136.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.06 / $48.34 / $102.84	Professional	26	$26.06	$48.34	$102.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.81 / $34.65 / $62.28	Professional	TC	$22.81	$34.65	$62.28
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.04 / $99.47 / $152.25	Professional		$57.04	$99.47	$152.25
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.01 / $50.88 / $77.88	Professional	26	$25.01	$50.88	$77.88
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.50 / $48.59 / $87.42	Professional	TC	$26.50	$48.59	$87.42
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $17.45 / $41.44 / $56.45	Professional		$17.45	$41.44	$56.45
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $34.32 / $39.26 / $42.55	Professional	26	$34.32	$39.26	$42.55
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $41.44 / $41.44 / $45.80	Professional	TC	$41.44	$41.44	$45.80
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.75 / $71.09 / $131.51	Professional		$68.75	$71.09	$131.51
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.65 / $56.62 / $77.70	Professional	26	$37.65	$56.62	$77.70
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.72 / $32.72 / $33.06	Professional	TC	$32.72	$32.72	$33.06
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $83.61 / $83.61 / $146.00	Facility		$83.61	$83.61	$146.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $78.29 / $78.29 / $78.29	Facility	26	$78.29	$78.29	$78.29
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $67.70 / $67.70 / $67.70	Facility	TC	$67.70	$67.70	$67.70
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $41.49 / $77.64 / $208.80	Professional		$41.49	$77.64	$208.80
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $39.57 / $87.31	Professional	26	$20.00	$39.57	$87.31
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $19.72 / $38.36 / $109.98	Professional	TC	$19.72	$38.36	$109.98
United Facility/Professional Professional Modifier Low / Median / High Price $36.86 / $49.96 / $134.19	Professional		$36.86	$49.96	$134.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.36 / $26.03 / $79.70	Professional	26	$19.36	$26.03	$79.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.62 / $23.66 / $66.26	Professional	TC	$17.62	$23.66	$66.26
Univera Facility/Professional Professional Modifier Low / Median / High Price $62.52 / $78.34 / $183.49	Professional		$62.52	$78.34	$183.49
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $25.01 / $40.07 / $93.85	Professional	26	$25.01	$40.07	$93.85
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $32.78 / $38.27 / $89.63	Professional	TC	$32.78	$38.27	$89.63