Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.18 / $111.15 / $163.78	Facility	26	$81.18	$111.15	$163.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.10 / $443.67 / $868.96	Professional		$216.10	$443.67	$868.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.90 / $116.64 / $237.15	Professional	26	$68.90	$116.64	$237.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $105.22 / $187.50 / $300.00	Professional	52	$105.22	$187.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.74 / $275.95 / $456.73	Professional	TC	$135.74	$275.95	$456.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.96 / $152.18 / $289.95	Professional		$126.96	$152.18	$289.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.25 / $55.45 / $99.66	Professional	26	$51.25	$55.45	$99.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $86.30 / $86.30 / $86.30	Professional	TC	$86.30	$86.30	$86.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.33 / $254.03 / $952.28	Professional		$194.33	$254.03	$952.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.23 / $82.42 / $168.25	Professional	26	$65.23	$82.42	$168.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $129.10 / $163.69 / $604.35	Professional	TC	$129.10	$163.69	$604.35
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $102.03 / $196.13 / $298.16	Professional		$102.03	$196.13	$298.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $483.73 / $1,091.71	Professional		$165.96	$483.73	$1,091.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $100.39 / $219.41	Professional	26	$53.70	$100.39	$219.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.70 / $328.55 / $839.23	Professional	TC	$111.70	$328.55	$839.23
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $199.36 / $291.74 / $710.64	Professional		$199.36	$291.74	$710.64
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.11 / $90.76 / $158.63	Professional	26	$66.11	$90.76	$158.63
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.87 / $165.82 / $302.10	Professional	TC	$126.87	$165.82	$302.10
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $180.47 / $321.30 / $505.00	Professional		$180.47	$321.30	$505.00
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.24 / $83.61 / $147.40	Professional	26	$33.24	$83.61	$147.40
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.36 / $233.21 / $303.00	Professional	TC	$114.36	$233.21	$303.00
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $205.30 / $208.54 / $210.43	Professional		$205.30	$208.54	$210.43
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $52.29 / $52.29 / $52.29	Professional	26	$52.29	$52.29	$52.29
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $203.61 / $266.57 / $477.85	Professional		$203.61	$266.57	$477.85
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.20 / $91.15 / $149.27	Professional	26	$75.20	$91.15	$149.27
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $129.30 / $129.30 / $130.72	Professional	52	$129.30	$129.30	$130.72
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.35 / $171.69 / $171.69	Professional	TC	$169.35	$171.69	$171.69
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $198.49 / $497.03 / $1,082.54	Professional		$198.49	$497.03	$1,082.54
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $54.26 / $105.80 / $219.41	Professional	26	$54.26	$105.80	$219.41
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $111.70 / $370.00 / $758.21	Professional	TC	$111.70	$370.00	$758.21
United Facility/Professional Professional Modifier Low / Median / High Price $178.22 / $254.30 / $680.41	Professional		$178.22	$254.30	$680.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $76.41 / $201.42	Professional	26	$60.26	$76.41	$201.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $118.40 / $165.20 / $487.79	Professional	TC	$118.40	$165.20	$487.79
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $82.23 / $82.23 / $238.82	Facility	26	$82.23	$82.23	$238.82
Univera Facility/Professional Professional Modifier Low / Median / High Price $197.58 / $299.83 / $537.48	Professional		$197.58	$299.83	$537.48
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $33.24 / $106.72 / $192.82	Professional	26	$33.24	$106.72	$192.82
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $126.22 / $209.60 / $344.66	Professional	TC	$126.22	$209.60	$344.66