Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $12.96 / $27.03	Facility	26	$10.47	$12.96	$27.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.86 / $59.31 / $140.66	Professional		$46.86	$59.31	$140.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.83 / $13.84 / $34.01	Professional	26	$10.83	$13.84	$34.01
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.43 / $28.14 / $37.65	Professional	52	$23.43	$28.14	$37.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.39 / $43.99 / $77.70	Professional	TC	$36.39	$43.99	$77.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $51.59 / $53.38 / $85.22	Professional		$51.59	$53.38	$85.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.30 / $12.94 / $22.18	Professional	26	$10.30	$12.94	$22.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $37.65 / $37.65 / $37.65	Professional	TC	$37.65	$37.65	$37.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.91 / $57.71 / $107.07	Professional		$47.91	$57.71	$107.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $11.99 / $22.74	Professional	26	$9.66	$11.99	$22.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.25 / $45.00 / $80.94	Professional	TC	$38.25	$45.00	$80.94
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $17.19 / $59.00 / $76.20	Professional		$17.19	$59.00	$76.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.55 / $13.55 / $13.55	Facility	26	$13.55	$13.55	$13.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.35 / $82.14 / $176.89	Professional		$57.35	$82.14	$176.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.03 / $17.57 / $36.64	Professional	26	$12.03	$17.57	$36.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.93 / $64.37 / $136.63	Professional	TC	$44.93	$64.37	$136.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $60.47 / $78.61 / $119.94	Professional		$60.47	$78.61	$119.94
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.07 / $15.69 / $24.09	Professional	26	$12.07	$15.69	$24.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.39 / $63.43 / $96.73	Professional	TC	$50.39	$63.43	$96.73
Excellus BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $11.10 / $11.10 / $11.10	Facility	26	$11.10	$11.10	$11.10
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.51 / $59.69 / $111.81	Professional		$38.51	$59.69	$111.81
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.01 / $14.74 / $25.19	Professional	26	$9.01	$14.74	$25.19
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.25 / $47.04 / $87.84	Professional	TC	$30.25	$47.04	$87.84
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $11.26 / $11.26 / $13.28	Professional	26	$11.26	$11.26	$13.28
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.84 / $73.36 / $126.98	Professional		$61.84	$73.36	$126.98
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $16.60 / $24.87	Professional	26	$12.86	$16.60	$24.87
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $13.55 / $13.55 / $13.55	Facility	26	$13.55	$13.55	$13.55
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $56.79 / $78.53 / $163.85	Professional		$56.79	$78.53	$163.85
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $12.67 / $16.70 / $33.25	Professional	26	$12.67	$16.70	$33.25
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $43.73 / $56.85 / $124.74	Professional	TC	$43.73	$56.85	$124.74
United Facility/Professional Professional Modifier Low / Median / High Price $46.88 / $61.48 / $119.75	Professional		$46.88	$61.48	$119.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.14 / $13.71 / $28.42	Professional	26	$10.14	$13.71	$28.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.78 / $47.20 / $92.87	Professional	TC	$35.78	$47.20	$92.87
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $11.10 / $14.74 / $25.77	Facility	26	$11.10	$14.74	$25.77
Univera Facility/Professional Professional Modifier Low / Median / High Price $43.00 / $69.28 / $140.82	Professional		$43.00	$69.28	$140.82
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $9.01 / $14.85 / $30.19	Professional	26	$9.01	$14.85	$30.19
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $33.99 / $54.43 / $110.63	Professional	TC	$33.99	$54.43	$110.63