Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $147.91 / $323.59	Facility	26	$77.62	$147.91	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $891.25 / $2,570.40	Professional		$724.44	$891.25	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $102.33 / $316.23	Professional	26	$77.62	$102.33	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $794.33 / $1,778.28	Professional	TC	$645.65	$794.33	$1,778.28
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $954.99 / $2,454.71	Professional		$758.58	$954.99	$2,454.71
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $229.09	Professional	26	$75.86	$95.50	$229.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $831.76 / $1,949.84	Professional	TC	$676.08	$831.76	$1,949.84
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $1,148.15 / $1,288.25	Professional		$141.25	$1,148.15	$1,288.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.44 / $109.65 / $158.49	Facility	26	$23.44	$109.65	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,621.81 / $3,715.35	Professional		$707.95	$1,621.81	$3,715.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $144.54 / $446.68	Professional	26	$72.44	$144.54	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $1,513.56 / $3,311.31	Professional	TC	$645.65	$1,513.56	$3,311.31
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,122.02 / $1,659.59	Professional		$851.14	$1,122.02	$1,659.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $125.89 / $204.17	Professional	26	$95.50	$125.89	$204.17
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $1,000.00 / $1,445.44	Professional	TC	$794.33	$1,000.00	$1,445.44
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $812.83 / $1,513.56	Professional		$316.23	$812.83	$1,513.56
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $177.83	Professional	26	$79.43	$114.82	$177.83
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $724.44 / $1,318.26	Professional	TC	$190.55	$724.44	$1,318.26
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $204.17 / $489.78	Professional	26	$204.17	$204.17	$489.78
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,288.25 / $1,380.38	Professional		$1,096.48	$1,288.25	$1,380.38
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $144.54	Professional	26	$114.82	$138.04	$144.54
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $1,148.15 / $1,230.27	Professional	TC	$977.24	$1,148.15	$1,230.27
United Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,000.00 / $2,238.72	Professional		$776.25	$1,000.00	$2,238.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $234.42	Professional	26	$83.18	$109.65	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $933.25 / $2,041.74	Professional	TC	$691.83	$933.25	$2,041.74
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $102.33 / $123.03	Facility	26	$74.13	$102.33	$123.03
Univera Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $912.01 / $1,737.80	Professional		$660.69	$912.01	$1,737.80
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $120.23 / $204.17	Professional	26	$74.13	$120.23	$204.17
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $812.83 / $1,513.56	Professional	TC	$575.44	$812.83	$1,513.56