Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.39 / $66.61 / $114.81	Facility	26	$50.39	$66.61	$114.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.45 / $300.85 / $1,067.00	Professional		$197.45	$300.85	$1,067.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.93 / $93.06 / $300.00	Professional	26	$52.93	$93.06	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.87 / $204.22 / $451.33	Professional	TC	$135.87	$204.22	$451.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.24 / $200.20 / $468.77	Professional		$169.24	$200.20	$468.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.95 / $43.50 / $97.84	Professional	26	$39.95	$43.50	$97.84
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $370.93 / $370.93 / $370.93	Professional	TC	$370.93	$370.93	$370.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $201.58 / $263.51 / $700.76	Professional		$201.58	$263.51	$700.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $51.82 / $180.82	Professional	26	$39.64	$51.82	$180.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $161.94 / $205.33 / $496.03	Professional	TC	$161.94	$205.33	$496.03
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $79.52 / $310.41 / $389.94	Professional		$79.52	$310.41	$389.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $260.11 / $487.19 / $1,034.38	Professional		$260.11	$487.19	$1,034.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.71 / $103.25 / $194.19	Professional	26	$50.71	$103.25	$194.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $371.25 / $842.41	Professional	TC	$204.17	$371.25	$842.41
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $277.79 / $361.13 / $522.55	Professional		$277.79	$361.13	$522.55
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.66 / $72.97 / $110.84	Professional	26	$59.66	$72.97	$110.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $237.16 / $316.04 / $441.38	Professional	TC	$237.16	$316.04	$441.38
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.78 / $308.85 / $554.65	Professional		$194.78	$308.85	$554.65
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.36 / $77.48 / $115.75	Professional	26	$48.36	$77.48	$115.75
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $123.34 / $244.39 / $438.90	Professional	TC	$123.34	$244.39	$438.90
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $180.69 / $253.35 / $268.25	Professional		$180.69	$253.35	$268.25
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $56.69 / $65.63 / $70.30	Professional	26	$56.69	$65.63	$70.30
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $317.68 / $355.99 / $422.51	Professional		$317.68	$355.99	$422.51
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.84 / $75.95 / $133.22	Professional	26	$68.84	$75.95	$133.22
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $254.06 / $416.99 / $987.16	Professional		$254.06	$416.99	$987.16
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $54.82 / $87.96 / $182.35	Professional	26	$54.82	$87.96	$182.35
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $213.45 / $300.60 / $805.98	Professional	TC	$213.45	$300.60	$805.98
United Facility/Professional Professional Modifier Low / Median / High Price $242.84 / $329.64 / $778.89	Professional		$242.84	$329.64	$778.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.15 / $71.39 / $159.01	Professional	26	$50.15	$71.39	$159.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.24 / $265.89 / $615.35	Professional	TC	$195.24	$265.89	$615.35
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $64.45 / $64.45 / $294.60	Facility	26	$64.45	$64.45	$294.60
Univera Facility/Professional Professional Modifier Low / Median / High Price $213.65 / $326.35 / $699.64	Professional		$213.65	$326.35	$699.64
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $54.79 / $68.48 / $146.47	Professional	26	$54.79	$68.48	$146.47
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $145.16 / $257.30 / $528.94	Professional	TC	$145.16	$257.30	$528.94