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 / $110.86	Facility	26	$48.13	$58.32	$110.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.50 / $171.00 / $421.25	Professional		$64.50	$171.00	$421.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.12 / $58.32 / $127.79	Professional	26	$44.12	$58.32	$127.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $112.22 / $196.90 / $300.22	Professional	50	$112.22	$196.90	$300.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.67 / $147.47 / $254.67	Professional	TC	$97.67	$147.47	$254.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.03 / $98.55 / $132.13	Professional		$86.03	$98.55	$132.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.22 / $41.99 / $55.38	Professional	26	$34.22	$41.99	$55.38
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.55 / $169.35 / $505.24	Professional		$129.55	$169.35	$505.24
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 $194.32 / $246.40 / $723.40	Professional	50	$194.32	$246.40	$723.40
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.93 / $108.96 / $350.10	Professional	TC	$85.93	$108.96	$350.10
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $69.06 / $127.38 / $196.44	Professional		$69.06	$127.38	$196.44
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 $125.29 / $288.72 / $688.42	Professional		$125.29	$288.72	$688.42
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 $231.80 / $231.80 / $264.70	Professional	50	$231.80	$231.80	$264.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.25 / $215.53 / $485.67	Professional	TC	$81.25	$215.53	$485.67
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $135.10 / $197.01 / $342.95	Professional		$135.10	$197.01	$342.95
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 $85.17 / $118.06 / $206.36	Professional	TC	$85.17	$118.06	$206.36
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.55 / $202.19 / $275.44	Professional		$122.55	$202.19	$275.44
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 $78.20 / $146.16 / $216.17	Professional	TC	$78.20	$146.16	$216.17
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $142.60 / $142.60 / $142.60	Professional		$142.60	$142.60	$142.60
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.21 / $171.57 / $321.83	Professional		$160.21	$171.57	$321.83
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.34 / $56.93 / $112.55	Professional	26	$44.34	$56.93	$112.55
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 $150.11 / $243.35 / $624.39	Professional		$150.11	$243.35	$624.39
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $66.03 / $142.00	Professional	26	$36.54	$66.03	$142.00
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $231.80 / $231.80 / $264.70	Professional	50	$231.80	$231.80	$264.70
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $97.59 / $155.10 / $401.27	Professional	TC	$97.59	$155.10	$401.27
United Facility/Professional Professional Modifier Low / Median / High Price $125.24 / $189.96 / $438.53	Professional		$125.24	$189.96	$438.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.35 / $55.02 / $128.16	Professional	26	$40.35	$55.02	$128.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.72 / $126.13 / $321.04	Professional	TC	$80.72	$126.13	$321.04
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 $133.34 / $218.14 / $361.60	Professional		$133.34	$218.14	$361.60
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 $85.50 / $139.21 / $232.87	Professional	TC	$85.50	$139.21	$232.87