Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.78 / $44.34 / $152.15	Facility	26	$27.78	$44.34	$152.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.59 / $147.29 / $537.69	Professional		$106.59	$147.29	$537.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.17 / $41.37 / $103.02	Professional	26	$29.17	$41.37	$103.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.81 / $147.30 / $580.79	Professional	52	$37.81	$147.30	$580.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.81 / $99.73 / $187.33	Professional	TC	$78.81	$99.73	$187.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.57 / $100.47 / $121.61	Professional		$83.57	$100.47	$121.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.72 / $32.39 / $51.53	Professional	26	$26.72	$32.39	$51.53
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	52	$25.12	$25.12	$25.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $107.21 / $107.21 / $107.21	Professional	TC	$107.21	$107.21	$107.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.52 / $118.31 / $346.21	Professional		$91.52	$118.31	$346.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.14 / $31.56 / $80.64	Professional	26	$24.14	$31.56	$80.64
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.36 / $86.75 / $231.12	Professional	TC	$66.36	$86.75	$231.12
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $52.87 / $132.15 / $185.02	Professional		$52.87	$132.15	$185.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.25 / $191.35 / $413.90	Professional		$104.25	$191.35	$413.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.39 / $49.44 / $108.14	Professional	26	$26.39	$49.44	$108.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.14 / $141.07 / $305.31	Professional	TC	$76.14	$141.07	$305.31
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $129.69 / $174.58 / $306.32	Professional		$129.69	$174.58	$306.32
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.50 / $47.64 / $97.22	Professional	26	$35.50	$47.64	$97.22
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.19 / $128.22 / $198.43	Professional	TC	$94.19	$128.22	$198.43
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.90 / $150.40 / $269.52	Professional		$103.90	$150.40	$269.52
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.62 / $47.77 / $76.73	Professional	26	$29.62	$47.77	$76.73
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.27 / $107.58 / $192.79	Professional	TC	$69.27	$107.58	$192.79
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $131.44 / $151.19 / $238.91	Professional		$131.44	$151.19	$238.91
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $32.27 / $40.34 / $42.79	Professional	26	$32.27	$40.34	$42.79
Fidelis Facility/Professional Professional Modifier 52 Low / Median / High Price $65.73 / $65.73 / $65.73	Professional	52	$65.73	$65.73	$65.73
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.91 / $152.57 / $243.80	Professional		$131.91	$152.57	$243.80
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.20 / $45.82 / $76.92	Professional	26	$38.20	$45.82	$76.92
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $34.89 / $80.50 / $121.90	Professional	52	$34.89	$80.50	$121.90
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.46 / $121.54 / $125.18	Professional	TC	$93.46	$121.54	$125.18
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $113.17 / $200.00 / $402.21	Professional		$113.17	$200.00	$402.21
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $27.56 / $49.44 / $107.78	Professional	26	$27.56	$49.44	$107.78
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $79.02 / $134.35 / $294.43	Professional	TC	$79.02	$134.35	$294.43
United Facility/Professional Professional Modifier Low / Median / High Price $103.09 / $146.66 / $319.06	Professional		$103.09	$146.66	$319.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.79 / $41.65 / $87.21	Professional	26	$27.79	$41.65	$87.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.47 / $104.57 / $211.90	Professional	TC	$79.47	$104.57	$211.90
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $38.63 / $38.63 / $51.82	Facility	26	$38.63	$38.63	$51.82
Univera Facility/Professional Professional Modifier Low / Median / High Price $109.59 / $189.17 / $324.82	Professional		$109.59	$189.17	$324.82
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $54.21 / $92.48	Professional	26	$36.54	$54.21	$92.48
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $69.27 / $134.96 / $232.34	Professional	TC	$69.27	$134.96	$232.34