Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.29 / $114.74 / $238.89	Facility	26	$88.29	$114.74	$238.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.58 / $385.43 / $670.86	Professional		$242.58	$385.43	$670.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.06 / $97.01 / $217.70	Professional	26	$78.06	$97.01	$217.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $622.86 / $622.86 / $622.86	Professional	50	$622.86	$622.86	$622.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.13 / $293.97 / $496.36	Professional	TC	$169.13	$293.97	$496.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $84.70 / $127.05	Professional	26	$65.88	$84.70	$127.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $274.61 / $350.37 / $963.21	Professional		$274.61	$350.37	$963.21
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.06 / $96.46 / $211.94	Professional	26	$76.06	$96.46	$211.94
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $411.92 / $517.44 / $1,356.10	Professional	50	$411.92	$517.44	$1,356.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.54 / $252.37 / $692.29	Professional	TC	$198.54	$252.37	$692.29
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $129.41 / $244.15 / $373.56	Professional		$129.41	$244.15	$373.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $270.93 / $610.72 / $1,641.14	Professional		$270.93	$610.72	$1,641.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.01 / $125.56 / $276.60	Professional	26	$67.01	$125.56	$276.60
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $523.66	Professional	50	$458.57	$458.57	$523.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.92 / $493.73 / $1,230.58	Professional	TC	$203.92	$493.73	$1,230.58
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $280.29 / $379.94 / $682.28	Professional		$280.29	$379.94	$682.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.09 / $115.73 / $185.00	Professional	26	$84.09	$115.73	$185.00
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.07 / $244.50 / $391.95	Professional	TC	$187.07	$244.50	$391.95
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $252.71 / $405.51 / $573.39	Professional		$252.71	$405.51	$573.39
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $62.80 / $128.65 / $186.32	Professional	26	$62.80	$128.65	$186.32
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $153.91 / $285.17 / $395.14	Professional	TC	$153.91	$285.17	$395.14
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $361.96 / $716.56 / $716.56	Professional		$361.96	$716.56	$716.56
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $105.55 / $127.33 / $197.12	Professional	26	$105.55	$127.33	$197.12
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $517.13 / $1,269.61	Professional		$275.00	$517.13	$1,269.61
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $68.87 / $121.44 / $272.38	Professional	26	$68.87	$121.44	$272.38
MVP Health Care Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $523.66	Professional	50	$458.57	$458.57	$523.66
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $216.33 / $379.73 / $961.82	Professional	TC	$216.33	$379.73	$961.82
United Facility/Professional Professional Modifier Low / Median / High Price $285.17 / $432.08 / $987.70	Professional		$285.17	$432.08	$987.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.34 / $103.51 / $278.76	Professional	26	$76.34	$103.51	$278.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $219.81 / $314.85 / $722.14	Professional	TC	$219.81	$314.85	$722.14
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $103.94 / $103.94 / $299.05	Facility	26	$103.94	$103.94	$299.05
Univera Facility/Professional Professional Modifier Low / Median / High Price $267.42 / $430.41 / $718.60	Professional		$267.42	$430.41	$718.60
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $62.80 / $136.77 / $239.56	Professional	26	$62.80	$136.77	$239.56
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $177.23 / $300.14 / $474.46	Professional	TC	$177.23	$300.14	$474.46