Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $57.54 / $181.97	Facility	26	$46.77	$57.54	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $190.55 / $588.84	Professional		$85.11	$190.55	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $83.18 / $245.47	Professional	26	$41.69	$83.18	$245.47
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $323.59 / $416.87	Professional	50	$173.78	$323.59	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $52.48 / $107.15	Professional	TC	$39.81	$52.48	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $89.13 / $123.03	Professional		$81.28	$89.13	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $60.26	Professional	26	$40.74	$51.29	$60.26
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $177.83	Professional		$87.10	$102.33	$177.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $45.71 / $85.11	Professional	26	$37.15	$45.71	$85.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $57.54 / $91.20	Professional	TC	$47.86	$57.54	$91.20
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $79.43 / $144.54	Professional		$64.57	$79.43	$144.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $50.12 / $72.44	Facility	26	$10.72	$50.12	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $144.54 / $436.52	Professional		$77.62	$144.54	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $70.79 / $177.83	Professional	26	$34.67	$70.79	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $75.86 / $218.78	Professional	TC	$43.65	$75.86	$218.78
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $154.88 / $208.93	Professional		$104.71	$154.88	$208.93
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $95.50	Professional	26	$45.71	$67.61	$95.50
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $85.11 / $112.20	Professional	TC	$60.26	$85.11	$112.20
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $91.20 / $204.17	Professional		$66.07	$91.20	$204.17
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $95.50	Professional	26	$34.67	$45.71	$95.50
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $48.98 / $109.65	Professional	TC	$35.48	$48.98	$109.65
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $93.33 / $123.03	Professional		$79.43	$93.33	$123.03
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $54.95 / $66.07	Professional	26	$53.70	$54.95	$66.07
Fidelis Facility/Professional Professional Modifier 50 Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	50	$218.78	$218.78	$218.78
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $109.65 / $158.49	Professional		$100.00	$109.65	$158.49
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $51.29 / $95.50	Professional	26	$46.77	$51.29	$95.50
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $199.53 / $213.80 / $467.74	Professional	50	$199.53	$213.80	$467.74
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $134.90 / $251.19	Professional		$112.20	$134.90	$251.19
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $117.49	Professional	26	$52.48	$64.57	$117.49
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $70.79 / $134.90	Professional	TC	$58.88	$70.79	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $109.65 / $269.15	Professional		$79.43	$109.65	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $51.29 / $125.89	Professional	26	$38.02	$51.29	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $57.54 / $141.25	Professional	TC	$41.69	$57.54	$141.25
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $52.48 / $100.00	Facility	26	$31.62	$52.48	$100.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $102.33 / $245.47	Professional		$69.18	$102.33	$245.47
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $52.48 / $114.82	Professional	26	$35.48	$52.48	$114.82
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $54.95 / $128.82	Professional	TC	$35.48	$54.95	$128.82