Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.25 / $45.44 / $112.99	Facility	26	$28.25	$45.44	$112.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.58 / $436.79 / $1,138.20	Professional		$245.58	$436.79	$1,138.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.25 / $43.28 / $104.91	Professional	26	$28.25	$43.28	$104.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.34 / $399.06 / $1,031.84	Professional	TC	$217.34	$399.06	$1,031.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Professional	26	$53.70	$53.70	$53.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $352.16 / $446.53 / $887.51	Professional		$352.16	$446.53	$887.51
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.19 / $42.90 / $89.03	Professional	26	$33.19	$42.90	$89.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $318.97 / $404.45 / $762.50	Professional	TC	$318.97	$404.45	$762.50
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $558.59 / $619.89	Professional		$61.30	$558.59	$619.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.92 / $47.92 / $47.92	Facility	26	$47.92	$47.92	$47.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $314.70 / $629.35 / $1,369.32	Professional		$314.70	$629.35	$1,369.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.66 / $55.84 / $123.86	Professional	26	$29.66	$55.84	$123.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $284.12 / $583.38 / $1,245.69	Professional	TC	$284.12	$583.38	$1,245.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $378.74 / $525.05 / $790.50	Professional		$378.74	$525.05	$790.50
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $51.82 / $87.05	Professional	26	$36.90	$51.82	$87.05
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $319.75 / $463.64 / $743.40	Professional	TC	$319.75	$463.64	$743.40
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.43 / $321.23 / $626.99	Professional		$143.43	$321.23	$626.99
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.96 / $42.43 / $73.28	Professional	26	$24.96	$42.43	$73.28
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.06 / $286.88 / $559.94	Professional	TC	$86.06	$286.88	$559.94
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $406.55 / $406.55 / $406.55	Professional		$406.55	$406.55	$406.55
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $463.23 / $463.23 / $622.62	Professional		$463.23	$463.23	$622.62
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.07 / $54.00 / $102.26	Professional	26	$50.07	$54.00	$102.26
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $47.92 / $47.92 / $47.92	Facility	26	$47.92	$47.92	$47.92
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $313.77 / $636.55 / $1,317.51	Professional		$313.77	$636.55	$1,317.51
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $32.33 / $57.37 / $123.86	Professional	26	$32.33	$57.37	$123.86
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $320.32 / $583.38 / $1,245.69	Professional	TC	$320.32	$583.38	$1,245.69
United Facility/Professional Professional Modifier Low / Median / High Price $383.95 / $504.37 / $1,096.34	Professional		$383.95	$504.37	$1,096.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.28 / $48.54 / $106.81	Professional	26	$36.28	$48.54	$106.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $347.69 / $462.14 / $992.81	Professional	TC	$347.69	$462.14	$992.81
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $90.02	Facility	26	$44.86	$44.86	$90.02
Univera Facility/Professional Professional Modifier Low / Median / High Price $273.33 / $528.41 / $931.37	Professional		$273.33	$528.41	$931.37
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $24.96 / $56.50 / $99.41	Professional	26	$24.96	$56.50	$99.41
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $248.38 / $471.92 / $841.35	Professional	TC	$248.38	$471.92	$841.35