Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.70 / $101.74 / $223.02	Facility	26	$83.70	$101.74	$223.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.52 / $367.73 / $718.14	Professional		$231.52	$367.73	$718.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.17 / $91.51 / $214.06	Professional	26	$74.17	$91.51	$214.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.81 / $295.64 / $499.87	Professional	TC	$166.81	$295.64	$499.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.05 / $173.33 / $282.97	Professional		$91.05	$173.33	$282.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.02 / $77.88 / $160.54	Professional	26	$61.02	$77.88	$160.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.75 / $327.79 / $955.12	Professional		$250.75	$327.79	$955.12
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.17 / $94.60 / $196.73	Professional	26	$76.17	$94.60	$196.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.58 / $221.36 / $712.12	Professional	TC	$174.58	$221.36	$712.12
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $120.48 / $244.25 / $364.73	Professional		$120.48	$244.25	$364.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.53 / $602.74 / $1,441.45	Professional		$229.53	$602.74	$1,441.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $116.24 / $257.02	Professional	26	$62.72	$116.24	$257.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.81 / $474.49 / $1,044.83	Professional	TC	$166.81	$474.49	$1,044.83
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $273.83 / $371.19 / $791.81	Professional		$273.83	$371.19	$791.81
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.84 / $106.72 / $171.25	Professional	26	$77.84	$106.72	$171.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.21 / $255.34 / $394.56	Professional	TC	$184.21	$255.34	$394.56
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $246.77 / $395.66 / $547.95	Professional		$246.77	$395.66	$547.95
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.65 / $119.09 / $172.90	Professional	26	$57.65	$119.09	$172.90
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $153.91 / $300.70 / $372.19	Professional	TC	$153.91	$300.70	$372.19
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $58.11 / $75.53 / $81.59	Professional	26	$58.11	$75.53	$81.59
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $279.92 / $306.12 / $737.43	Professional		$279.92	$306.12	$737.43
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $88.43 / $106.10 / $202.36	Professional	26	$88.43	$106.10	$202.36
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $477.95 / $1,223.02	Professional		$275.00	$477.95	$1,223.02
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $64.26 / $113.65 / $252.16	Professional	26	$64.26	$113.65	$252.16
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $171.17 / $309.14 / $1,016.28	Professional	TC	$171.17	$309.14	$1,016.28
United Facility/Professional Professional Modifier Low / Median / High Price $237.65 / $360.58 / $840.70	Professional		$237.65	$360.58	$840.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.83 / $94.44 / $219.06	Professional	26	$70.83	$94.44	$219.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.64 / $257.10 / $639.87	Professional	TC	$179.64	$257.10	$639.87
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $281.11	Facility	26	$96.46	$96.46	$281.11
Univera Facility/Professional Professional Modifier Low / Median / High Price $260.93 / $422.63 / $701.83	Professional		$260.93	$422.63	$701.83
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $57.65 / $126.92 / $227.37	Professional	26	$57.65	$126.92	$227.37
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $177.23 / $300.70 / $474.46	Professional	TC	$177.23	$300.70	$474.46