Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.15 / $128.93 / $244.34	Facility	26	$111.15	$128.93	$244.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $334.68 / $475.00 / $1,387.75	Professional		$334.68	$475.00	$1,387.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.55 / $151.58 / $363.80	Professional	26	$105.55	$151.58	$363.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $163.31 / $201.04 / $417.89	Professional	52	$163.31	$201.04	$417.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.20 / $335.00 / $701.95	Professional	TC	$234.20	$335.00	$701.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $211.69 / $252.07 / $319.58	Professional		$211.69	$252.07	$319.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.25 / $92.59 / $229.44	Professional	26	$79.25	$92.59	$229.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $149.74 / $149.74 / $176.07	Professional	TC	$149.74	$149.74	$176.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $324.39 / $424.05 / $1,479.82	Professional		$324.39	$424.05	$1,479.82
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $99.41 / $126.05 / $257.80	Professional	26	$99.41	$126.05	$257.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $224.98 / $285.27 / $1,020.98	Professional	TC	$224.98	$285.27	$1,020.98
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $158.25 / $341.65 / $499.90	Professional		$158.25	$341.65	$499.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $282.95 / $769.21 / $2,272.92	Professional		$282.95	$769.21	$2,272.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.84 / $150.90 / $335.35	Professional	26	$81.84	$150.90	$335.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $198.98 / $559.16 / $1,577.46	Professional	TC	$198.98	$559.16	$1,577.46
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $333.52 / $487.73 / $1,358.71	Professional		$333.52	$487.73	$1,358.71
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.32 / $141.31 / $247.00	Professional	26	$102.32	$141.31	$247.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.04 / $287.68 / $523.80	Professional	TC	$220.04	$287.68	$523.80
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $300.72 / $513.01 / $678.93	Professional		$300.72	$513.01	$678.93
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.69 / $128.47 / $226.49	Professional	26	$52.69	$128.47	$226.49
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.40 / $365.41 / $459.95	Professional	TC	$198.40	$365.41	$459.95
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $330.37 / $343.22 / $352.05	Professional		$330.37	$343.22	$352.05
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $79.98 / $95.21 / $105.06	Professional	26	$79.98	$95.21	$105.06
Fidelis Facility/Professional Professional Modifier TC Low / Median / High Price $503.56 / $503.56 / $503.56	Professional	TC	$503.56	$503.56	$503.56
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $341.42 / $438.37 / $797.93	Professional		$341.42	$438.37	$797.93
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $119.47 / $151.94 / $230.22	Professional	26	$119.47	$151.94	$230.22
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $298.87 / $298.87 / $298.87	Professional	TC	$298.87	$298.87	$298.87
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $123.88 / $123.88 / $123.88	Facility	26	$123.88	$123.88	$123.88
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $335.50 / $750.00 / $1,885.30	Professional		$335.50	$750.00	$1,885.30
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $83.98 / $160.34 / $335.35	Professional	26	$83.98	$160.34	$335.35
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $198.98 / $530.00 / $1,217.69	Professional	TC	$198.98	$530.00	$1,217.69
United Facility/Professional Professional Modifier Low / Median / High Price $302.08 / $433.36 / $1,471.56	Professional		$302.08	$433.36	$1,471.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.42 / $117.40 / $309.39	Professional	26	$93.42	$117.40	$309.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $202.68 / $289.14 / $934.52	Professional	TC	$202.68	$289.14	$934.52
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $126.35 / $126.35 / $368.63	Facility	26	$126.35	$126.35	$368.63
Univera Facility/Professional Professional Modifier Low / Median / High Price $328.67 / $500.00 / $897.52	Professional		$328.67	$500.00	$897.52
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $52.69 / $163.82 / $285.52	Professional	26	$52.69	$163.82	$285.52
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $219.02 / $363.62 / $599.92	Professional	TC	$219.02	$363.62	$599.92