Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.00 / $111.15 / $175.56	Facility	26	$72.00	$111.15	$175.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.07 / $375.00 / $917.52	Professional		$145.07	$375.00	$917.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.42 / $122.95 / $213.35	Professional	26	$65.42	$122.95	$213.35
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $261.31 / $261.31 / $1,218.00	Professional	50	$261.31	$261.31	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $111.46 / $187.50 / $300.00	Professional	52	$111.46	$187.50	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.19 / $282.87 / $483.17	Professional	TC	$165.19	$282.87	$483.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.87 / $160.72 / $195.43	Professional		$134.87	$160.72	$195.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.44 / $49.88 / $91.02	Professional	26	$44.44	$49.88	$91.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $206.13 / $269.45 / $881.02	Professional		$206.13	$269.45	$881.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.25 / $74.81 / $153.44	Professional	26	$60.25	$74.81	$153.44
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $309.20 / $392.06 / $1,155.25	Professional	50	$309.20	$392.06	$1,155.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $145.88 / $184.97 / $566.59	Professional	TC	$145.88	$184.97	$566.59
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $94.10 / $221.33 / $315.43	Professional		$94.10	$221.33	$315.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.63 / $490.76 / $1,047.64	Professional		$176.63	$490.76	$1,047.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $91.72 / $200.64	Professional	26	$49.61	$91.72	$200.64
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $343.71	Professional	50	$301.29	$301.29	$343.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.63 / $358.95 / $821.97	Professional	TC	$126.63	$358.95	$821.97
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $213.15 / $311.66 / $691.74	Professional		$213.15	$311.66	$691.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.44 / $82.85 / $144.81	Professional	26	$60.44	$82.85	$144.81
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.94 / $190.65 / $347.80	Professional	TC	$145.94	$190.65	$347.80
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $191.92 / $330.02 / $505.00	Professional		$191.92	$330.02	$505.00
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.66 / $76.43 / $134.74	Professional	26	$30.66	$76.43	$134.74
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.47 / $246.72 / $303.00	Professional	TC	$131.47	$246.72	$303.00
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $219.32 / $223.02 / $384.41	Professional		$219.32	$223.02	$384.41
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $57.33 / $57.33 / $57.33	Professional	26	$57.33	$57.33	$57.33
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.48 / $281.27 / $376.26	Professional		$229.48	$281.27	$376.26
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.70 / $90.13 / $137.77	Professional	26	$81.70	$90.13	$137.77
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $544.67 / $544.67 / $547.67	Professional	50	$544.67	$544.67	$547.67
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $209.51 / $501.81 / $1,048.35	Professional		$209.51	$501.81	$1,048.35
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $49.90 / $98.85 / $209.00	Professional	26	$49.90	$98.85	$209.00
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $343.71	Professional	50	$301.29	$301.29	$343.71
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $126.63 / $370.00 / $780.72	Professional	TC	$126.63	$370.00	$780.72
United Facility/Professional Professional Modifier Low / Median / High Price $193.05 / $273.89 / $742.48	Professional		$193.05	$273.89	$742.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $69.62 / $157.50	Professional	26	$55.00	$69.62	$157.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $136.30 / $186.10 / $552.08	Professional	TC	$136.30	$186.10	$552.08
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $75.17 / $75.17 / $216.75	Facility	26	$75.17	$75.17	$216.75
Univera Facility/Professional Professional Modifier Low / Median / High Price $209.36 / $316.39 / $569.27	Professional		$209.36	$316.39	$569.27
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $30.66 / $97.99 / $177.23	Professional	26	$30.66	$97.99	$177.23
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $144.13 / $240.97 / $392.04	Professional	TC	$144.13	$240.97	$392.04