Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.00 / $62.90 / $117.11	Facility	26	$51.00	$62.90	$117.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.44 / $198.41 / $440.45	Professional		$134.44	$198.41	$440.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.06 / $54.64 / $149.78	Professional	26	$42.06	$54.64	$149.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $67.23 / $85.50 / $161.63	Professional	52	$67.23	$85.50	$161.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.57 / $143.72 / $291.63	Professional	TC	$85.57	$143.72	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.38 / $105.39 / $127.07	Professional		$88.38	$105.39	$127.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.69 / $44.27 / $83.97	Professional	26	$37.69	$44.27	$83.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.53 / $93.53 / $93.53	Professional	TC	$93.53	$93.53	$93.53
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.44 / $173.15 / $519.04	Professional		$132.44	$173.15	$519.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.85 / $59.41 / $122.12	Professional	26	$46.85	$59.41	$122.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.60 / $109.06 / $353.92	Professional	TC	$85.60	$109.06	$353.92
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $74.48 / $126.90 / $201.40	Professional		$74.48	$126.90	$201.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.72 / $300.00 / $687.82	Professional		$128.72	$300.00	$687.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.45 / $71.90 / $168.32	Professional	26	$37.45	$71.90	$168.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.94 / $209.68 / $450.83	Professional	TC	$80.94	$209.68	$450.83
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.47 / $199.30 / $373.09	Professional		$138.47	$199.30	$373.09
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.09 / $65.95 / $115.29	Professional	26	$48.09	$65.95	$115.29
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.50 / $117.13 / $204.73	Professional	TC	$84.50	$117.13	$204.73
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.68 / $207.83 / $283.12	Professional		$125.68	$207.83	$283.12
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $73.58 / $107.18	Professional	26	$33.56	$73.58	$107.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $146.16 / $219.02	Professional	TC	$77.59	$146.16	$219.02
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $137.28 / $144.90 / $250.44	Professional		$137.28	$144.90	$250.44
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $37.72 / $44.92 / $60.10	Professional	26	$37.72	$44.92	$60.10
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $140.60 / $164.79 / $325.45	Professional		$140.60	$164.79	$325.45
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.75 / $63.58 / $124.88	Professional	26	$56.75	$63.58	$124.88
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.50 / $103.50 / $115.77	Professional	TC	$103.50	$103.50	$115.77
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $153.86 / $250.01 / $631.73	Professional		$153.86	$250.01	$631.73
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $38.58 / $71.94 / $158.47	Professional	26	$38.58	$71.94	$158.47
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $97.59 / $148.26 / $404.56	Professional	TC	$97.59	$148.26	$404.56
United Facility/Professional Professional Modifier Low / Median / High Price $126.43 / $191.90 / $444.85	Professional		$126.43	$191.90	$444.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.62 / $59.32 / $129.24	Professional	26	$45.62	$59.32	$129.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.81 / $120.26 / $277.77	Professional	TC	$80.81	$120.26	$277.77
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $59.79 / $59.79 / $186.34	Facility	26	$59.79	$59.79	$186.34
Univera Facility/Professional Professional Modifier Low / Median / High Price $137.06 / $223.72 / $372.28	Professional		$137.06	$223.72	$372.28
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $78.68 / $140.31	Professional	26	$33.56	$78.68	$140.31
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $85.17 / $138.12 / $231.98	Professional	TC	$85.17	$138.12	$231.98