Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.89 / $106.31 / $232.87	Facility	26	$90.89	$106.31	$232.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.07 / $373.14 / $895.23	Professional		$288.07	$373.14	$895.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.45 / $95.62 / $263.26	Professional	26	$76.45	$95.62	$263.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.91 / $261.88 / $540.76	Professional	TC	$217.91	$261.88	$540.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.51 / $239.83 / $290.27	Professional		$199.51	$239.83	$290.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.81 / $77.34 / $177.52	Professional	26	$63.81	$77.34	$177.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $244.43 / $244.43 / $244.43	Professional	TC	$244.43	$244.43	$244.43
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $312.54 / $388.12 / $837.63	Professional		$312.54	$388.12	$837.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $98.68 / $204.74	Professional	26	$79.45	$98.68	$204.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $233.07 / $283.64 / $588.09	Professional	TC	$233.07	$283.64	$588.09
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $341.17 / $467.06	Professional		$125.89	$341.17	$467.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $252.22 / $488.28 / $1,256.31	Professional		$252.22	$488.28	$1,256.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.43 / $121.14 / $258.68	Professional	26	$65.43	$121.14	$258.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $184.84 / $348.62 / $1,014.04	Professional	TC	$184.84	$348.62	$1,014.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $309.58 / $426.86 / $625.37	Professional		$309.58	$426.86	$625.37
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.50 / $113.75 / $179.30	Professional	26	$81.50	$113.75	$179.30
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $224.75 / $294.02 / $470.36	Professional	TC	$224.75	$294.02	$470.36
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $252.74 / $338.28 / $644.92	Professional		$252.74	$338.28	$644.92
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.65 / $124.69 / $180.01	Professional	26	$65.65	$124.69	$180.01
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $182.20 / $253.96 / $464.92	Professional	TC	$182.20	$253.96	$464.92
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $313.75 / $331.18 / $570.27	Professional		$313.75	$331.18	$570.27
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $63.87 / $74.36 / $76.04	Professional	26	$63.87	$74.36	$76.04
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $326.43 / $366.28 / $609.88	Professional		$326.43	$366.28	$609.88
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.02 / $123.87 / $210.58	Professional	26	$95.02	$123.87	$210.58
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $320.27 / $320.27 / $320.27	Professional	TC	$320.27	$320.27	$320.27
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $263.36 / $451.82 / $1,193.09	Professional		$263.36	$451.82	$1,193.09
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $67.47 / $118.33 / $255.63	Professional	26	$67.47	$118.33	$255.63
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $188.57 / $324.55 / $759.26	Professional	TC	$188.57	$324.55	$759.26
United Facility/Professional Professional Modifier Low / Median / High Price $268.64 / $350.68 / $780.28	Professional		$268.64	$350.68	$780.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.17 / $97.94 / $223.49	Professional	26	$74.17	$97.94	$223.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.03 / $257.02 / $529.91	Professional	TC	$187.03	$257.02	$529.91
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $100.42 / $100.42 / $196.33	Facility	26	$100.42	$100.42	$196.33
Univera Facility/Professional Professional Modifier Low / Median / High Price $261.12 / $473.43 / $790.16	Professional		$261.12	$473.43	$790.16
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $65.65 / $132.13 / $220.55	Professional	26	$65.65	$132.13	$220.55
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $195.47 / $341.28 / $569.62	Professional	TC	$195.47	$341.28	$569.62