Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.35 / $102.81 / $270.24	Facility		$56.35	$102.81	$270.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.69 / $22.26 / $30.72	Facility	26	$16.69	$22.26	$30.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $39.65 / $81.97 / $173.80	Facility	TC	$39.65	$81.97	$173.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.35 / $76.76 / $345.78	Professional		$56.35	$76.76	$345.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.14 / $58.86 / $393.83	Professional	26	$18.14	$58.86	$393.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.25 / $50.00 / $172.34	Professional	TC	$38.25	$50.00	$172.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.91 / $85.91 / $85.91	Professional		$85.91	$85.91	$85.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.01 / $26.01 / $29.08	Professional	26	$26.01	$26.01	$29.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $77.61 / $203.43	Professional		$37.86	$77.61	$203.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.95 / $24.21 / $64.38	Professional	26	$11.95	$24.21	$64.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.92 / $53.67 / $139.72	Professional	TC	$25.92	$53.67	$139.72
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $16.88 / $40.31 / $89.28	Facility		$16.88	$40.31	$89.28
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $40.31 / $66.03 / $129.59	Professional		$40.31	$66.03	$129.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $132.13 / $159.19 / $176.16	Facility		$132.13	$159.19	$176.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $71.22 / $71.22	Facility	26	$71.22	$71.22	$71.22
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $104.94 / $104.94 / $104.94	Facility	TC	$104.94	$104.94	$104.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.99 / $93.16 / $240.21	Professional		$39.99	$93.16	$240.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $29.10 / $68.73	Professional	26	$12.37	$29.10	$68.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $65.38 / $156.38	Professional	TC	$27.87	$65.38	$156.38
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $36.00 / $36.00 / $36.00	Facility		$36.00	$36.00	$36.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $60.90 / $93.14 / $185.83	Professional		$60.90	$93.14	$185.83
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $28.30 / $49.46	Professional	26	$19.80	$28.30	$49.46
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.06 / $66.69 / $120.73	Professional	TC	$44.06	$66.69	$120.73
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.21 / $98.49 / $191.40	Professional		$52.21	$98.49	$191.40
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.28 / $30.03 / $58.36	Professional	26	$17.28	$30.03	$58.36
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.93 / $68.45 / $133.04	Professional	TC	$34.93	$68.45	$133.04
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $10.25 / $24.34 / $107.33	Professional		$10.25	$24.34	$107.33
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $10.25 / $28.18 / $38.26	Professional	26	$10.25	$28.18	$38.26
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.72 / $108.72 / $167.05	Professional		$108.72	$108.72	$167.05
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.55 / $31.92 / $58.38	Professional	26	$28.55	$31.92	$58.38
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $159.19 / $159.19 / $176.16	Facility		$159.19	$159.19	$176.16
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $71.22 / $71.22	Facility	26	$71.22	$71.22	$71.22
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $104.94 / $104.94 / $104.94	Facility	TC	$104.94	$104.94	$104.94
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $42.11 / $93.48 / $226.02	Professional		$42.11	$93.48	$226.02
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $12.37 / $26.52 / $58.97	Professional	26	$12.37	$26.52	$58.97
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $66.95 / $146.83	Professional	TC	$28.37	$66.95	$146.83
United Facility/Professional Professional Modifier Low / Median / High Price $44.54 / $60.73 / $140.34	Professional		$44.54	$60.73	$140.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.15 / $19.63 / $49.91	Professional	26	$13.15	$19.63	$49.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.18 / $46.20 / $116.24	Professional	TC	$34.18	$46.20	$116.24
Univera Facility/Professional Professional Modifier Low / Median / High Price $73.06 / $98.49 / $230.67	Professional		$73.06	$98.49	$230.67
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $26.03 / $30.03 / $70.33	Professional	26	$26.03	$30.03	$70.33
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $44.28 / $68.45 / $156.50	Professional	TC	$44.28	$68.45	$156.50