Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $102.33 / $223.87	Facility	26	$87.10	$102.33	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $380.19 / $1,096.48	Professional		$223.87	$380.19	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $91.20 / $263.03	Professional	26	$74.13	$91.20	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $239.88 / $602.56	Professional	TC	$162.18	$239.88	$602.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $91.20 / $218.78	Professional		$79.43	$91.20	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $64.57 / $151.36	Professional	26	$45.71	$64.57	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	TC	$147.91	$147.91	$147.91
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $309.03 / $812.83	Professional		$251.19	$309.03	$812.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $181.97	Professional	26	$75.86	$95.50	$181.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $218.78 / $549.54	Professional	TC	$173.78	$218.78	$549.54
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $245.47 / $363.08	Professional		$120.23	$245.47	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $134.90	Facility	26	$19.95	$93.33	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $562.34 / $1,995.26	Professional		$251.19	$562.34	$1,995.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $117.49 / $338.84	Professional	26	$64.57	$117.49	$338.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $426.58 / $1,548.82	Professional	TC	$177.83	$426.58	$1,548.82
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $354.81 / $524.81	Professional		$275.42	$354.81	$524.81
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $117.49 / $407.38	Professional	26	$81.28	$117.49	$407.38
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $257.04 / $371.54	Professional	TC	$190.55	$257.04	$371.54
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $426.58 / $676.08	Professional		$245.47	$426.58	$676.08
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $120.23 / $208.93	Professional	26	$67.61	$120.23	$208.93
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $302.00 / $467.74	Professional	TC	$162.18	$302.00	$467.74
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $302.00 / $630.96	Professional		$269.15	$302.00	$630.96
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $97.72 / $169.82	Professional	26	$85.11	$97.72	$169.82
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $407.38 / $741.31	Professional		$338.84	$407.38	$741.31
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $120.23 / $218.78	Professional	26	$100.00	$120.23	$218.78
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $281.84 / $524.81	Professional	TC	$239.88	$281.84	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $363.08 / $812.83	Professional		$239.88	$363.08	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $89.13 / $190.55	Professional	26	$67.61	$89.13	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $251.19 / $616.60	Professional	TC	$169.82	$251.19	$616.60
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $95.50 / $281.84	Facility	26	$67.61	$95.50	$281.84
Univera Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $380.19 / $741.31	Professional		$245.47	$380.19	$741.31
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $120.23 / $239.88	Professional	26	$67.61	$120.23	$239.88
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $295.12 / $537.03	Professional	TC	$154.88	$295.12	$537.03