Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $112.20 / $169.82	Facility	26	$81.28	$112.20	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $426.58 / $1,445.44	Professional		$199.53	$426.58	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $104.71 / $302.00	Professional	26	$66.07	$104.71	$302.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $75.86 / $169.82 / $524.81	Professional	52	$75.86	$169.82	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $257.04 / $588.84	Professional	TC	$138.04	$257.04	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $331.13	Professional		$134.90	$154.88	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $72.44 / $131.83	Professional	26	$38.90	$72.44	$131.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $234.42	Professional	TC	$120.23	$120.23	$234.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $251.19 / $794.33	Professional		$199.53	$251.19	$794.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $81.28 / $158.49	Professional	26	$64.57	$81.28	$158.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $165.96 / $501.19	Professional	TC	$134.90	$165.96	$501.19
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $204.17 / $302.00	Professional		$102.33	$204.17	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $40.74 / $61.66	Facility	53	$22.91	$40.74	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $501.19 / $2,187.76	Professional		$199.53	$501.19	$2,187.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $109.65 / $288.40	Professional	26	$54.95	$109.65	$288.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $346.74 / $1,621.81	Professional	TC	$128.82	$346.74	$1,621.81
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $269.15 / $446.68	Professional		$204.17	$269.15	$446.68
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $100.00 / $213.80	Professional	26	$69.18	$100.00	$213.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $181.97 / $269.15	Professional	TC	$138.04	$181.97	$269.15
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $338.84 / $501.19	Professional		$186.21	$338.84	$501.19
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $112.20 / $162.18	Professional	26	$57.54	$112.20	$162.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $251.19 / $323.59	Professional	TC	$120.23	$251.19	$323.59
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $50.12 / $64.57	Professional	26	$50.12	$50.12	$64.57
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $323.59 / $323.59	Professional	TC	$323.59	$323.59	$323.59
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $501.19	Professional		$213.80	$269.15	$501.19
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $89.13 / $147.91	Professional	26	$66.07	$89.13	$147.91
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $131.83 / $131.83 / $134.90	Professional	52	$131.83	$131.83	$134.90
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $181.97 / $181.97	Professional	TC	$181.97	$181.97	$181.97
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $524.81 / $724.44	Professional		$269.15	$524.81	$724.44
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $186.21 / $208.93	Professional	26	$93.33	$186.21	$208.93
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $371.54 / $512.86	Professional	TC	$181.97	$371.54	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $251.19 / $691.83	Professional		$173.78	$251.19	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $165.96	Professional	26	$57.54	$74.13	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $162.18 / $524.81	Professional	TC	$114.82	$162.18	$524.81
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $81.28 / $239.88	Facility	26	$57.54	$81.28	$239.88
Univera Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $338.84 / $602.56	Professional		$186.21	$338.84	$602.56
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $102.33 / $204.17	Professional	26	$57.54	$102.33	$204.17
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $223.87 / $380.19	Professional	TC	$120.23	$223.87	$380.19