Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.44 / $29.75 / $67.81	Facility	26	$22.44	$29.75	$67.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.68 / $181.63 / $341.21	Professional		$116.68	$181.63	$341.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.76 / $25.45 / $66.38	Professional	26	$18.76	$25.45	$66.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.23 / $161.38 / $274.45	Professional	TC	$94.23	$161.38	$274.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.41 / $84.41 / $84.41	Professional		$84.41	$84.41	$84.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.21 / $35.21 / $41.79	Professional	26	$35.21	$35.21	$41.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.51 / $120.94 / $359.01	Professional		$92.51	$120.94	$359.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.89 / $23.00 / $53.47	Professional	26	$17.89	$23.00	$53.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.61 / $97.53 / $294.27	Professional	TC	$74.61	$97.53	$294.27
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $34.40 / $147.81 / $182.22	Professional		$34.40	$147.81	$182.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.83 / $216.89 / $467.08	Professional		$119.83	$216.89	$467.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $33.76 / $80.01	Professional	26	$20.23	$33.76	$80.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.05 / $183.57 / $399.55	Professional	TC	$96.05	$183.57	$399.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $119.60 / $180.19 / $238.77	Professional		$119.60	$180.19	$238.77
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.98 / $31.39 / $46.98	Professional	26	$23.98	$31.39	$46.98
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.55 / $142.15 / $213.23	Professional	TC	$114.55	$142.15	$213.23
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.63 / $153.08 / $261.11	Professional		$98.63	$153.08	$261.11
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.14 / $29.12 / $49.68	Professional	26	$19.14	$29.12	$49.68
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.51 / $123.96 / $211.44	Professional	TC	$81.51	$123.96	$211.44
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $95.42 / $95.42 / $95.42	Professional		$95.42	$95.42	$95.42
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.98 / $199.98 / $199.98	Professional		$199.98	$199.98	$199.98
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.34 / $28.34 / $28.65	Professional	26	$28.34	$28.34	$28.65
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $27.06 / $27.06 / $27.06	Facility	26	$27.06	$27.06	$27.06
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $127.90 / $194.95 / $433.57	Professional		$127.90	$194.95	$433.57
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $21.70 / $33.57 / $76.86	Professional	26	$21.70	$33.57	$76.86
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $102.51 / $141.59 / $383.88	Professional	TC	$102.51	$141.59	$383.88
United Facility/Professional Professional Modifier Low / Median / High Price $111.66 / $149.52 / $334.69	Professional		$111.66	$149.52	$334.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.05 / $28.30 / $64.34	Professional	26	$20.05	$28.30	$64.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.14 / $125.15 / $294.18	Professional	TC	$92.14	$125.15	$294.18
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $27.66 / $27.66 / $67.13	Facility	26	$27.66	$27.66	$67.13
Univera Facility/Professional Professional Modifier Low / Median / High Price $123.59 / $153.69 / $325.49	Professional		$123.59	$153.69	$325.49
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $19.38 / $29.29 / $62.89	Professional	26	$19.38	$29.29	$62.89
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $100.08 / $124.65 / $262.61	Professional	TC	$100.08	$124.65	$262.61