Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.80 / $30.25 / $42.03	Facility	26	$21.80	$30.25	$42.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.56 / $209.81 / $425.57	Professional		$156.56	$209.81	$425.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.80 / $26.24 / $55.71	Professional	26	$21.80	$26.24	$55.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.77 / $186.50 / $360.18	Professional	TC	$134.77	$186.50	$360.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $286.32 / $286.32 / $286.32	Professional		$286.32	$286.32	$286.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.37 / $41.37 / $41.37	Professional	26	$41.37	$41.37	$41.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.37 / $157.35 / $439.73	Professional		$120.37	$157.35	$439.73
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.41 / $22.76 / $56.53	Professional	26	$17.41	$22.76	$56.53
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $102.96 / $134.59 / $380.33	Professional	TC	$102.96	$134.59	$380.33
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $34.04 / $195.55 / $229.59	Professional		$34.04	$195.55	$229.59
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 $156.63 / $289.94 / $590.16	Professional		$156.63	$289.94	$590.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.49 / $36.84 / $78.55	Professional	26	$21.49	$36.84	$78.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $129.16 / $242.61 / $551.34	Professional	TC	$129.16	$242.61	$551.34
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $183.36 / $221.77 / $319.72	Professional		$183.36	$221.77	$319.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.34 / $31.84 / $47.65	Professional	26	$24.34	$31.84	$47.65
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $155.91 / $193.58 / $290.37	Professional	TC	$155.91	$193.58	$290.37
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.70 / $187.93 / $334.79	Professional		$109.70	$187.93	$334.79
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.38 / $29.12 / $49.68	Professional	26	$19.38	$29.12	$49.68
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.42 / $168.36 / $285.11	Professional	TC	$93.42	$168.36	$285.11
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $141.04 / $141.04 / $141.04	Professional		$141.04	$141.04	$141.04
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.92 / $25.92 / $25.92	Professional	26	$25.92	$25.92	$25.92
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 $151.93 / $246.84 / $550.02	Professional		$151.93	$246.84	$550.02
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $22.13 / $34.51 / $77.52	Professional	26	$22.13	$34.51	$77.52
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $137.69 / $190.04 / $507.16	Professional	TC	$137.69	$190.04	$507.16
United Facility/Professional Professional Modifier Low / Median / High Price $144.78 / $197.85 / $430.32	Professional		$144.78	$197.85	$430.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $28.33 / $62.45	Professional	26	$21.57	$28.33	$62.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.03 / $168.10 / $366.99	Professional	TC	$121.03	$168.10	$366.99
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $27.66 / $27.66 / $83.32	Facility	26	$27.66	$27.66	$83.32
Univera Facility/Professional Professional Modifier Low / Median / High Price $158.46 / $197.37 / $412.67	Professional		$158.46	$197.37	$412.67
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $19.38 / $29.29 / $63.08	Professional	26	$19.38	$29.29	$63.08
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $134.94 / $168.09 / $349.59	Professional	TC	$134.94	$168.09	$349.59