Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.13 / $58.32 / $127.79	Facility	26	$48.13	$58.32	$127.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.88 / $200.82 / $434.00	Professional		$84.88	$200.82	$434.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.12 / $58.32 / $129.60	Professional	26	$44.12	$58.32	$129.60
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $200.41 / $200.41 / $200.41	Professional	50	$200.41	$200.41	$200.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $110.84 / $162.25 / $291.63	Professional	TC	$110.84	$162.25	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.90 / $107.07 / $161.44	Professional		$101.90	$107.07	$161.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.22 / $44.47 / $66.70	Professional	26	$34.22	$44.47	$66.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.62 / $193.31 / $503.96	Professional		$149.62	$193.31	$503.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.62 / $55.02 / $113.15	Professional	26	$43.62	$55.02	$113.15
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $224.43 / $279.20 / $719.71	Professional	50	$224.43	$279.20	$719.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.00 / $132.76 / $351.53	Professional	TC	$106.00	$132.76	$351.53
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $69.06 / $148.86 / $217.93	Professional		$69.06	$148.86	$217.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.65 / $297.76 / $823.87	Professional		$135.65	$297.76	$823.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.90 / $66.89 / $147.91	Professional	26	$35.90	$66.89	$147.91
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $231.34 / $264.19	Professional	50	$231.34	$231.34	$264.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.74 / $228.32 / $584.02	Professional	TC	$99.74	$228.32	$584.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $161.15 / $218.45 / $372.44	Professional		$161.15	$218.45	$372.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.34 / $60.57 / $105.87	Professional	26	$44.34	$60.57	$105.87
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.02 / $152.51 / $266.57	Professional	TC	$110.02	$152.51	$266.57
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.40 / $233.38 / $323.20	Professional		$141.40	$233.38	$323.20
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.51 / $67.84 / $98.82	Professional	26	$33.51	$67.84	$98.82
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.87 / $162.62 / $222.75	Professional	TC	$85.87	$162.62	$222.75
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $161.15 / $161.15 / $161.15	Professional		$161.15	$161.15	$161.15
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.19 / $177.63 / $211.28	Professional		$145.19	$177.63	$211.28
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.21 / $56.62 / $114.58	Professional	26	$52.21	$56.62	$114.58
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $165.88 / $260.70 / $650.10	Professional		$165.88	$260.70	$650.10
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $66.47 / $142.00	Professional	26	$36.54	$66.47	$142.00
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $231.34 / $264.19	Professional	50	$231.34	$231.34	$264.19
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $111.04 / $185.72 / $473.20	Professional	TC	$111.04	$185.72	$473.20
United Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $218.46 / $477.11	Professional		$145.22	$218.46	$477.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.59 / $52.37 / $115.86	Professional	26	$39.59	$52.37	$115.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.78 / $154.91 / $355.01	Professional	TC	$103.78	$154.91	$355.01
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $55.13 / $55.13 / $175.69	Facility	26	$55.13	$55.13	$175.69
Univera Facility/Professional Professional Modifier Low / Median / High Price $153.91 / $249.68 / $410.72	Professional		$153.91	$249.68	$410.72
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $33.51 / $72.54 / $128.72	Professional	26	$33.51	$72.54	$128.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $106.07 / $179.51 / $281.98	Professional	TC	$106.07	$179.51	$281.98