Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.37 / $31.68 / $74.73	Facility	26	$20.37	$31.68	$74.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.07 / $88.15 / $239.99	Professional		$58.07	$88.15	$239.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.38 / $29.06 / $99.65	Professional	26	$20.38	$29.06	$99.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.68 / $36.45 / $121.84	Professional	52	$25.68	$36.45	$121.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $55.88 / $116.13	Professional	TC	$28.14	$55.88	$116.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.76 / $43.76 / $45.77	Professional		$43.76	$43.76	$45.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.77 / $21.03 / $56.30	Professional	26	$5.77	$21.03	$56.30
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $11.44 / $38.31 / $40.04	Professional	52	$11.44	$38.31	$40.04
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.75 / $69.43 / $203.78	Professional		$54.75	$69.43	$203.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $31.04 / $60.78	Professional	26	$25.00	$31.04	$60.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.75 / $37.72 / $136.28	Professional	TC	$29.75	$37.72	$136.28
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $40.07 / $54.33 / $94.40	Professional		$40.07	$54.33	$94.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.46 / $107.11 / $239.57	Professional		$51.46	$107.11	$239.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.11 / $37.54 / $82.86	Professional	26	$20.11	$37.54	$82.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.83 / $70.29 / $153.76	Professional	TC	$26.83	$70.29	$153.76
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $59.29 / $78.45 / $120.56	Professional		$59.29	$78.45	$120.56
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.59 / $35.15 / $56.39	Professional	26	$26.59	$35.15	$56.39
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.70 / $41.30 / $66.48	Professional	TC	$32.70	$41.30	$66.48
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.52 / $75.75 / $120.68	Professional		$46.52	$75.75	$120.68
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $35.88 / $57.46	Professional	26	$14.80	$35.88	$57.46
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $44.71 / $63.23	Professional	TC	$24.37	$44.71	$63.23
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $23.12 / $23.12 / $32.56	Professional		$23.12	$23.12	$32.56
Fidelis Facility/Professional Professional Modifier 52 Low / Median / High Price $31.30 / $31.30 / $31.30	Professional	52	$31.30	$31.30	$31.30
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.80 / $79.76 / $136.61	Professional		$67.80	$79.76	$136.61
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.21 / $30.36 / $58.08	Professional	26	$15.21	$30.36	$58.08
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $44.34 / $44.83 / $70.61	Professional	52	$44.34	$44.83	$70.61
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $30.97 / $30.97 / $30.97	Facility	26	$30.97	$30.97	$30.97
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $66.66 / $109.15 / $226.93	Professional		$66.66	$109.15	$226.93
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $22.20 / $38.13 / $79.61	Professional	26	$22.20	$38.13	$79.61
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $36.59 / $65.31 / $142.93	Professional	TC	$36.59	$65.31	$142.93
United Facility/Professional Professional Modifier Low / Median / High Price $51.94 / $76.09 / $173.35	Professional		$51.94	$76.09	$173.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.96 / $28.89 / $64.54	Professional	26	$21.96	$28.89	$64.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $50.89 / $134.16	Professional	TC	$30.85	$50.89	$134.16
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $31.53 / $31.53 / $88.02	Facility	26	$31.53	$31.53	$88.02
Univera Facility/Professional Professional Modifier Low / Median / High Price $57.47 / $76.53 / $150.69	Professional		$57.47	$76.53	$150.69
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $36.43 / $73.73	Professional	26	$14.80	$36.43	$73.73
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $30.11 / $44.71 / $76.95	Professional	TC	$30.11	$44.71	$76.95