Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $414.59 / $577.41 / $1,672.97	Facility	26	$414.59	$577.41	$1,672.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,788.24 / $2,326.09 / $5,314.49	Professional		$1,788.24	$2,326.09	$5,314.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $347.37 / $510.16 / $1,106.27	Professional	26	$347.37	$510.16	$1,106.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,373.65 / $1,920.41 / $3,839.19	Professional	TC	$1,373.65	$1,920.41	$3,839.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,484.67 / $1,484.67 / $2,041.42	Professional		$1,484.67	$1,484.67	$2,041.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $353.97 / $353.97 / $353.97	Professional	26	$353.97	$353.97	$353.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,612.98 / $2,070.60 / $4,962.66	Professional		$1,612.98	$2,070.60	$4,962.66
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $344.89 / $441.77 / $989.94	Professional	26	$344.89	$441.77	$989.94
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,268.08 / $1,607.91 / $3,950.48	Professional	TC	$1,268.08	$1,607.91	$3,950.48
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $592.85 / $2,067.38 / $2,660.23	Professional		$592.85	$2,067.38	$2,660.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $477.29 / $477.29 / $477.29	Facility	26	$477.29	$477.29	$477.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,695.98 / $2,843.24 / $6,023.63	Professional		$1,695.98	$2,843.24	$6,023.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $362.64 / $565.53 / $1,253.33	Professional	26	$362.64	$565.53	$1,253.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,333.34 / $2,319.46 / $4,987.10	Professional	TC	$1,333.34	$2,319.46	$4,987.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $1,714.40 / $2,424.40 / $3,771.68	Professional		$1,714.40	$2,424.40	$3,771.68
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $400.30 / $554.87 / $882.09	Professional	26	$400.30	$554.87	$882.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,435.68 / $1,990.05 / $3,478.40	Professional	TC	$1,435.68	$1,990.05	$3,478.40
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.64 / $1,778.56 / $3,418.33	Professional		$104.64	$1,778.56	$3,418.33
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $272.55 / $425.95 / $815.94	Professional	26	$272.55	$425.95	$815.94
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $62.78 / $1,488.37 / $2,629.26	Professional	TC	$62.78	$1,488.37	$2,629.26
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $442.97 / $442.97 / $442.97	Professional	26	$442.97	$442.97	$442.97
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,906.34 / $2,021.68 / $2,039.07	Professional		$1,906.34	$2,021.68	$2,039.07
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $439.54 / $630.23 / $1,018.69	Professional	26	$439.54	$630.23	$1,018.69
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $477.29 / $477.29 / $477.29	Facility	26	$477.29	$477.29	$477.29
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $1,872.00 / $2,842.26 / $6,243.75	Professional		$1,872.00	$2,842.26	$6,243.75
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $417.37 / $577.00 / $1,224.27	Professional	26	$417.37	$577.00	$1,224.27
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $1,421.69 / $2,146.90 / $4,778.18	Professional	TC	$1,421.69	$2,146.90	$4,778.18
United Facility/Professional Professional Modifier Low / Median / High Price $1,505.53 / $2,106.00 / $4,404.60	Professional		$1,505.53	$2,106.00	$4,404.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $338.38 / $465.27 / $1,068.38	Professional	26	$338.38	$465.27	$1,068.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,201.72 / $1,726.21 / $3,704.80	Professional	TC	$1,201.72	$1,726.21	$3,704.80
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $450.29 / $450.29 / $1,282.84	Facility	26	$450.29	$450.29	$1,282.84
Univera Facility/Professional Professional Modifier Low / Median / High Price $1,714.40 / $2,387.48 / $4,670.10	Professional		$1,714.40	$2,387.48	$4,670.10
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $272.55 / $551.11 / $1,218.43	Professional	26	$272.55	$551.11	$1,218.43
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $1,313.45 / $1,836.37 / $3,817.45	Professional	TC	$1,313.45	$1,836.37	$3,817.45