Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.54 / $105.90 / $197.16	Facility	26	$90.54	$105.90	$197.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.93 / $386.10 / $772.16	Professional		$251.93	$386.10	$772.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.13 / $97.15 / $250.60	Professional	26	$81.13	$97.15	$250.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $164.67 / $291.01 / $508.96	Professional	TC	$164.67	$291.01	$508.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.00 / $176.00 / $224.53	Professional		$176.00	$176.00	$224.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.58 / $70.84 / $167.50	Professional	26	$63.58	$70.84	$167.50
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $253.71 / $331.66 / $975.76	Professional		$253.71	$331.66	$975.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.13 / $99.01 / $204.90	Professional	26	$79.13	$99.01	$204.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.58 / $223.26 / $684.23	Professional	TC	$174.58	$223.26	$684.23
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $125.41 / $244.25 / $369.66	Professional		$125.41	$244.25	$369.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.41 / $578.85 / $1,439.16	Professional		$234.41	$578.85	$1,439.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.16 / $118.00 / $267.01	Professional	26	$65.16	$118.00	$267.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.25 / $429.21 / $1,037.77	Professional	TC	$169.25	$429.21	$1,037.77
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $277.80 / $376.58 / $704.29	Professional		$277.80	$376.58	$704.29
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.19 / $111.99 / $178.62	Professional	26	$81.19	$111.99	$178.62
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.42 / $244.95 / $392.66	Professional	TC	$187.42	$244.95	$392.66
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.95 / $400.77 / $555.03	Professional		$213.95	$400.77	$555.03
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.24 / $124.22 / $179.86	Professional	26	$63.24	$124.22	$179.86
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $143.47 / $282.74 / $372.19	Professional	TC	$143.47	$282.74	$372.19
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $293.24 / $293.24 / $293.24	Professional		$293.24	$293.24	$293.24
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $63.62 / $63.62 / $63.62	Professional	26	$63.62	$63.62	$63.62
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $280.63 / $347.73 / $692.90	Professional		$280.63	$347.73	$692.90
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.02 / $111.65 / $207.94	Professional	26	$95.02	$111.65	$207.94
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $199.23 / $231.98 / $238.94	Professional	TC	$199.23	$231.98	$238.94
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $98.41 / $98.41 / $98.41	Facility	26	$98.41	$98.41	$98.41
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $241.50 / $467.62 / $1,196.07	Professional		$241.50	$467.62	$1,196.07
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $67.06 / $117.86 / $258.44	Professional	26	$67.06	$117.86	$258.44
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $176.40 / $308.70 / $804.86	Professional	TC	$176.40	$308.70	$804.86
United Facility/Professional Professional Modifier Low / Median / High Price $252.49 / $367.89 / $846.81	Professional		$252.49	$367.89	$846.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.51 / $99.98 / $247.44	Professional	26	$73.51	$99.98	$247.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.53 / $254.08 / $562.54	Professional	TC	$170.53	$254.08	$562.54
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $100.34 / $100.34 / $301.30	Facility	26	$100.34	$100.34	$301.30
Univera Facility/Professional Professional Modifier Low / Median / High Price $264.30 / $431.16 / $710.19	Professional		$264.30	$431.16	$710.19
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $63.24 / $132.03 / $235.72	Professional	26	$63.24	$132.03	$235.72
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $177.23 / $300.70 / $474.46	Professional	TC	$177.23	$300.70	$474.46