Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $76.18 / $121.84 / $642.21	Facility		$76.18	$121.84	$642.21
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.35 / $27.50 / $37.75	Facility	26	$22.35	$27.50	$37.75
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $44.78 / $114.80 / $334.15	Facility	TC	$44.78	$114.80	$334.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.03 / $87.07 / $217.92	Professional		$64.03	$87.07	$217.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.35 / $47.38 / $134.18	Professional	26	$22.35	$47.38	$134.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.04 / $57.67 / $164.24	Professional	TC	$37.04	$57.67	$164.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $52.08 / $99.93	Professional		$52.08	$52.08	$99.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.08 / $35.79 / $39.78	Professional	26	$32.08	$35.79	$39.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $68.30 / $68.30 / $68.30	Professional	TC	$68.30	$68.30	$68.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $110.26 / $252.56	Professional		$44.64	$110.26	$252.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $41.27 / $96.45	Professional	26	$16.34	$41.27	$96.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.66 / $65.70 / $154.91	Professional	TC	$29.66	$65.70	$154.91
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $20.81 / $49.70 / $96.82	Facility		$20.81	$49.70	$96.82
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $49.33 / $74.65 / $146.52	Professional		$49.33	$74.65	$146.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.29 / $173.84 / $176.16	Facility		$144.29	$173.84	$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 $59.53 / $114.44 / $280.80	Professional		$59.53	$114.44	$280.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $43.15 / $97.27	Professional	26	$20.42	$43.15	$97.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.89 / $71.42 / $194.07	Professional	TC	$34.89	$71.42	$194.07
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $8.00 / $8.00 / $8.00	Facility		$8.00	$8.00	$8.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $70.98 / $119.31 / $216.67	Professional		$70.98	$119.31	$216.67
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $38.20 / $111.31	Professional	26	$24.38	$38.20	$111.31
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.27 / $76.23 / $137.50	Professional	TC	$50.27	$76.23	$137.50
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $84.74 / $115.16 / $223.81	Professional		$84.74	$115.16	$223.81
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.07 / $38.94 / $72.81	Professional	26	$28.07	$38.94	$72.81
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.84 / $77.70 / $151.00	Professional	TC	$50.84	$77.70	$151.00
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $10.25 / $21.52 / $125.13	Professional		$10.25	$21.52	$125.13
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $10.25 / $28.18 / $47.03	Professional	26	$10.25	$28.18	$47.03
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $10.25 / $24.34 / $24.34	Professional	TC	$10.25	$24.34	$24.34
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.12 / $104.82 / $201.81	Professional		$104.12	$104.82	$201.81
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.20 / $51.79 / $72.70	Professional	26	$35.20	$51.79	$72.70
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.58 / $68.58 / $69.27	Professional	TC	$68.58	$68.58	$69.27
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $173.84 / $173.84 / $176.16	Facility		$173.84	$173.84	$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 $49.94 / $109.01 / $286.35	Professional		$49.94	$109.01	$286.35
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $19.27 / $37.02 / $92.28	Professional	26	$19.27	$37.02	$92.28
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $35.53 / $76.34 / $160.35	Professional	TC	$35.53	$76.34	$160.35
United Facility/Professional Professional Modifier Low / Median / High Price $56.13 / $74.84 / $192.02	Professional		$56.13	$74.84	$192.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.02 / $24.50 / $73.58	Professional	26	$17.02	$24.50	$73.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.13 / $50.47 / $104.56	Professional	TC	$38.13	$50.47	$104.56
Univera Facility/Professional Professional Modifier Low / Median / High Price $84.74 / $115.16 / $269.72	Professional		$84.74	$115.16	$269.72
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $32.09 / $37.47 / $87.75	Professional	26	$32.09	$37.47	$87.75
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $51.35 / $77.70 / $176.79	Professional	TC	$51.35	$77.70	$176.79