Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.39 / $119.88 / $1,042.25	Facility		$68.39	$119.88	$1,042.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.72 / $23.30 / $32.79	Facility	26	$17.72	$23.30	$32.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.06 / $93.43 / $181.94	Professional		$60.06	$93.43	$181.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.90 / $18.55 / $28.45	Professional	26	$15.90	$18.55	$28.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.86 / $83.17 / $160.25	Professional	TC	$43.86	$83.17	$160.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.22 / $70.88 / $192.10	Professional		$54.22	$70.88	$192.10
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.78 / $18.36 / $36.38	Professional	26	$14.78	$18.36	$36.38
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.43 / $50.00 / $145.75	Professional	TC	$39.43	$50.00	$145.75
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $26.47 / $26.47 / $68.17	Facility		$26.47	$26.47	$68.17
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $26.47 / $68.17 / $94.64	Professional		$26.47	$68.17	$94.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $176.29 / $233.64	Facility		$75.31	$176.29	$233.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.51 / $135.41 / $292.77	Professional		$52.51	$135.41	$292.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.53 / $27.00 / $61.37	Professional	26	$13.53	$27.00	$61.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $109.79 / $249.62	Professional	TC	$38.65	$109.79	$249.62
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $51.57 / $79.43 / $332.00	Facility		$51.57	$79.43	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $77.29 / $92.46 / $146.27	Professional		$77.29	$92.46	$146.27
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.35 / $26.16 / $47.97	Professional	26	$20.35	$26.16	$47.97
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.73 / $73.53 / $108.31	Professional	TC	$56.73	$73.53	$108.31
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $90.90 / $90.90 / $90.90	Facility		$90.90	$90.90	$90.90
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.05 / $89.45 / $153.47	Professional		$61.05	$89.45	$153.47
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.62 / $18.55 / $41.99	Professional	26	$14.62	$18.55	$41.99
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.13 / $68.90 / $116.66	Professional	TC	$44.13	$68.90	$116.66
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $64.43 / $72.27 / $90.34	Professional		$64.43	$72.27	$90.34
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $165.70 / $386.04 / $507.29	Facility		$165.70	$386.04	$507.29
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.94 / $21.06 / $21.17	Professional	26	$20.94	$21.06	$21.17
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $75.31 / $229.88 / $597.00	Facility		$75.31	$229.88	$597.00
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $20.65 / $20.65 / $20.65	Facility	26	$20.65	$20.65	$20.65
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $66.00 / $124.28 / $280.36	Professional		$66.00	$124.28	$280.36
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $26.21 / $59.48	Professional	26	$14.08	$26.21	$59.48
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $46.63 / $96.25 / $233.01	Professional	TC	$46.63	$96.25	$233.01
United Facility/Professional Professional Modifier Low / Median / High Price $58.50 / $79.59 / $225.36	Professional		$58.50	$79.59	$225.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.30 / $20.58 / $45.90	Professional	26	$15.30	$20.58	$45.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.61 / $60.18 / $180.87	Professional	TC	$42.61	$60.18	$180.87
Univera Facility/Professional Facility Modifier Low / Median / High Price $78.12 / $78.12 / $317.94	Facility		$78.12	$78.12	$317.94
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $21.37 / $21.37 / $67.63	Facility	26	$21.37	$21.37	$67.63
Univera Facility/Professional Professional Modifier Low / Median / High Price $66.40 / $85.31 / $175.43	Professional		$66.40	$85.31	$175.43
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $14.62 / $21.82 / $46.72	Professional	26	$14.62	$21.82	$46.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $47.92 / $61.50 / $126.54	Professional	TC	$47.92	$61.50	$126.54