Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.25 / $138.25 / $138.25	Facility	26	$138.25	$138.25	$138.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.45 / $111.47 / $211.44	Professional		$87.45	$111.47	$211.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.59 / $82.05 / $112.19	Professional	26	$67.59	$82.05	$112.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.69 / $29.76 / $42.25	Professional	TC	$19.69	$29.76	$42.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.65 / $103.10 / $216.58	Professional		$81.65	$103.10	$216.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.08 / $80.91 / $168.45	Professional	26	$64.08	$80.91	$168.45
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $22.20 / $59.99	Professional	TC	$17.57	$22.20	$59.99
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $44.78 / $111.35 / $156.13	Professional		$44.78	$111.35	$156.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.92 / $86.92 / $86.92	Facility	26	$86.92	$86.92	$86.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.72 / $137.58 / $358.67	Professional		$98.72	$137.58	$358.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.34 / $107.42 / $256.45	Professional	26	$70.34	$107.42	$256.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.39 / $38.17 / $98.43	Professional	TC	$24.39	$38.17	$98.43
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $116.02 / $142.44 / $214.07	Professional		$116.02	$142.44	$214.07
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.08 / $104.43 / $156.28	Professional	26	$85.08	$104.43	$156.28
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.29 / $38.63 / $58.82	Professional	TC	$34.29	$38.63	$58.82
Excellus BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $72.02 / $72.02 / $72.02	Facility	26	$72.02	$72.02	$72.02
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.35 / $97.54 / $187.53	Professional		$85.35	$97.54	$187.53
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.04 / $71.97 / $134.38	Professional	26	$58.04	$71.97	$134.38
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.22 / $26.64 / $53.14	Professional	TC	$20.22	$26.64	$53.14
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $97.54 / $97.54 / $97.54	Professional		$97.54	$97.54	$97.54
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.81 / $122.06 / $213.98	Professional		$105.81	$122.06	$213.98
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $60.70 / $60.70 / $60.70	Professional	52	$60.70	$60.70	$60.70
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $86.92 / $86.92 / $86.92	Facility	26	$86.92	$86.92	$86.92
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $98.72 / $132.37 / $341.84	Professional		$98.72	$132.37	$341.84
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $69.80 / $99.17 / $238.58	Professional	26	$69.80	$99.17	$238.58
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $22.80 / $35.67 / $80.34	Professional	TC	$22.80	$35.67	$80.34
United Facility/Professional Professional Modifier Low / Median / High Price $79.53 / $104.22 / $217.14	Professional		$79.53	$104.22	$217.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.33 / $78.13 / $174.28	Professional	26	$63.33	$78.13	$174.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.23 / $28.03 / $54.47	Professional	TC	$20.23	$28.03	$54.47
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $72.02 / $72.02 / $72.02	Facility	26	$72.02	$72.02	$72.02
Univera Facility/Professional Professional Modifier Low / Median / High Price $87.90 / $98.65 / $198.04	Professional		$87.90	$98.65	$198.04
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $58.04 / $78.43 / $141.91	Professional	26	$58.04	$78.43	$141.91
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $24.86 / $32.68 / $56.12	Professional	TC	$24.86	$32.68	$56.12