Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.75 / $119.00 / $227.50	Facility	26	$104.75	$119.00	$227.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $284.87 / $451.70 / $990.21	Professional		$284.87	$451.70	$990.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.16 / $123.37 / $199.08	Professional	26	$85.16	$123.37	$199.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.85 / $201.04 / $319.86	Professional	52	$138.85	$201.04	$319.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $193.96 / $299.00 / $555.67	Professional	TC	$193.96	$299.00	$555.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $179.11 / $179.11 / $188.20	Professional		$179.11	$179.11	$188.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.42 / $59.86 / $173.49	Professional	26	$58.42	$59.86	$173.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $132.58 / $132.58	Professional	TC	$132.58	$132.58	$132.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $274.89 / $359.34 / $1,148.11	Professional		$274.89	$359.34	$1,148.11
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.68 / $97.15 / $200.76	Professional	26	$77.68	$97.15	$200.76
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $197.20 / $250.05 / $805.47	Professional	TC	$197.20	$250.05	$805.47
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $122.93 / $300.11 / $423.04	Professional		$122.93	$300.11	$423.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $240.35 / $616.39 / $1,440.40	Professional		$240.35	$616.39	$1,440.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.96 / $119.82 / $262.08	Professional	26	$63.96	$119.82	$262.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.55 / $457.77 / $1,064.55	Professional	TC	$174.55	$457.77	$1,064.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $283.14 / $389.91 / $830.83	Professional		$283.14	$389.91	$830.83
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.42 / $108.87 / $190.30	Professional	26	$79.42	$108.87	$190.30
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.89 / $254.74 / $464.05	Professional	TC	$194.89	$254.74	$464.05
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $255.11 / $437.57 / $576.11	Professional		$255.11	$437.57	$576.11
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.93 / $100.08 / $176.44	Professional	26	$39.93	$100.08	$176.44
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $175.68 / $306.57 / $399.67	Professional	TC	$175.68	$306.57	$399.67
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.80 / $371.45 / $849.21	Professional		$323.80	$371.45	$849.21
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.08 / $108.26 / $120.97	Professional	26	$107.08	$108.26	$120.97
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $283.62 / $653.90 / $1,385.22	Professional		$283.62	$653.90	$1,385.22
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $65.58 / $125.91 / $257.20	Professional	26	$65.58	$125.91	$257.20
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $174.55 / $512.61 / $984.32	Professional	TC	$174.55	$512.61	$984.32
United Facility/Professional Professional Modifier Low / Median / High Price $256.45 / $374.08 / $957.15	Professional		$256.45	$374.08	$957.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.13 / $91.77 / $218.30	Professional	26	$72.13	$91.77	$218.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.87 / $253.73 / $700.50	Professional	TC	$181.87	$253.73	$700.50
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $98.43 / $98.43 / $286.95	Facility	26	$98.43	$98.43	$286.95
Univera Facility/Professional Professional Modifier Low / Median / High Price $278.89 / $423.38 / $761.52	Professional		$278.89	$423.38	$761.52
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $39.93 / $127.64 / $232.21	Professional	26	$39.93	$127.64	$232.21
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $193.48 / $295.93 / $529.30	Professional	TC	$193.48	$295.93	$529.30