Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $94.60 / $94.60 / $1,868.29	Facility		$94.60	$94.60	$1,868.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.02 / $33.02 / $33.02	Facility	26	$33.02	$33.02	$33.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.34 / $120.95 / $307.62	Professional		$75.34	$120.95	$307.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $52.88 / $327.06	Professional	26	$33.75	$52.88	$327.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.60 / $72.68 / $187.20	Professional	TC	$41.60	$72.68	$187.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $106.77 / $106.77 / $106.77	Professional		$106.77	$106.77	$106.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.18 / $38.18 / $38.18	Professional	26	$38.18	$38.18	$38.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.58 / $139.78 / $322.08	Professional		$54.58	$139.78	$322.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $48.76 / $124.92	Professional	26	$20.42	$48.76	$124.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.86 / $79.14 / $204.22	Professional	TC	$35.86	$79.14	$204.22
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $24.95 / $59.58 / $113.05	Facility		$24.95	$59.58	$113.05
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $57.60 / $87.96 / $172.64	Professional		$57.60	$87.96	$172.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $168.32 / $202.79 / $209.62	Facility		$168.32	$202.79	$209.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.87 / $90.87 / $90.87	Facility	26	$90.87	$90.87	$90.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.02 / $142.22 / $339.72	Professional		$70.02	$142.22	$339.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.34 / $53.32 / $110.00	Professional	26	$24.34	$53.32	$110.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.82 / $85.28 / $216.73	Professional	TC	$41.82	$85.28	$216.73
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $125.00 / $125.00	Facility		$125.00	$125.00	$125.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $75.06 / $114.00 / $228.69	Professional		$75.06	$114.00	$228.69
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.59 / $35.77 / $72.52	Professional	26	$24.59	$35.77	$72.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.48 / $76.54 / $138.09	Professional	TC	$50.48	$76.54	$138.09
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.06 / $130.86 / $254.32	Professional		$73.06	$130.86	$254.32
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.23 / $48.55 / $86.61	Professional	26	$29.23	$48.55	$86.61
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.84 / $86.30 / $167.71	Professional	TC	$43.84	$86.30	$167.71
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $25.62 / $25.62 / $145.41	Professional		$25.62	$25.62	$145.41
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $25.62 / $25.62	Professional	26	$25.62	$25.62	$25.62
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.84 / $229.41 / $241.56	Professional		$159.84	$229.41	$241.56
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.20 / $69.64 / $87.03	Professional	26	$42.20	$69.64	$87.03
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $202.79 / $202.79 / $209.62	Facility		$202.79	$202.79	$209.62
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $90.87 / $90.87 / $90.87	Facility	26	$90.87	$90.87	$90.87
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $70.02 / $125.73 / $329.15	Professional		$70.02	$125.73	$329.15
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $23.05 / $44.66 / $106.07	Professional	26	$23.05	$44.66	$106.07
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $41.82 / $76.66 / $187.04	Professional	TC	$41.82	$76.66	$187.04
United Facility/Professional Professional Modifier Low / Median / High Price $60.56 / $90.19 / $227.82	Professional		$60.56	$90.19	$227.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.61 / $29.20 / $90.11	Professional	26	$21.61	$29.20	$90.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.95 / $59.76 / $122.85	Professional	TC	$40.95	$59.76	$122.85
Univera Facility/Professional Professional Modifier Low / Median / High Price $73.06 / $130.86 / $306.50	Professional		$73.06	$130.86	$306.50
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $29.52 / $44.57 / $104.38	Professional	26	$29.52	$44.57	$104.38
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $44.28 / $86.30 / $202.12	Professional	TC	$44.28	$86.30	$202.12