Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.85 / $143.10 / $268.81	Facility	26	$103.85	$143.10	$268.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $555.67 / $726.59 / $1,489.48	Professional		$555.67	$726.59	$1,489.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.86 / $133.44 / $459.78	Professional	26	$103.86	$133.44	$459.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $277.83 / $324.04 / $494.79	Professional	52	$277.83	$324.04	$494.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $451.81 / $602.07 / $1,289.58	Professional	TC	$451.81	$602.07	$1,289.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $579.34 / $579.34 / $606.98	Professional		$579.34	$579.34	$606.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $113.94 / $113.94 / $113.94	Professional	26	$113.94	$113.94	$113.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $368.28 / $481.42 / $1,387.15	Professional		$368.28	$481.42	$1,387.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.56 / $87.03 / $235.35	Professional	26	$66.56	$87.03	$235.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $301.70 / $394.39 / $1,066.95	Professional	TC	$301.70	$394.39	$1,066.95
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $170.86 / $692.89 / $863.76	Professional		$170.86	$692.89	$863.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $133.97 / $133.97 / $133.97	Facility	26	$133.97	$133.97	$133.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $489.14 / $1,073.46 / $2,237.34	Professional		$489.14	$1,073.46	$2,237.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.93 / $197.53 / $388.11	Professional	26	$88.93	$197.53	$388.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $400.22 / $859.12 / $1,784.23	Professional	TC	$400.22	$859.12	$1,784.23
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $512.59 / $660.00 / $1,219.56	Professional		$512.59	$660.00	$1,219.56
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.83 / $159.62 / $239.42	Professional	26	$127.83	$159.62	$239.42
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $604.60 / $784.49 / $1,044.32	Professional	TC	$604.60	$784.49	$1,044.32
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $539.04 / $776.99 / $1,418.34	Professional		$539.04	$776.99	$1,418.34
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.76 / $147.51 / $270.38	Professional	26	$102.76	$147.51	$270.38
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $436.28 / $629.49 / $1,147.96	Professional	TC	$436.28	$629.49	$1,147.96
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $1,472.18 / $1,472.18 / $1,472.18	Professional		$1,472.18	$1,472.18	$1,472.18
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $611.07 / $676.73 / $676.73	Professional		$611.07	$676.73	$676.73
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $136.74 / $136.74 / $284.05	Professional	26	$136.74	$136.74	$284.05
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $338.37 / $338.37 / $676.73	Professional	52	$338.37	$338.37	$676.73
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $539.99 / $539.99 / $539.99	Professional	TC	$539.99	$539.99	$539.99
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $133.97 / $133.97 / $133.97	Facility	26	$133.97	$133.97	$133.97
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $482.45 / $971.43 / $2,131.35	Professional		$482.45	$971.43	$2,131.35
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $95.92 / $184.36 / $383.49	Professional	26	$95.92	$184.36	$383.49
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $482.89 / $783.33 / $1,661.37	Professional	TC	$482.89	$783.33	$1,661.37
United Facility/Professional Professional Modifier Low / Median / High Price $534.63 / $736.12 / $1,709.17	Professional		$534.63	$736.12	$1,709.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.25 / $140.25 / $326.74	Professional	26	$103.25	$140.25	$326.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $428.55 / $589.55 / $1,426.36	Professional	TC	$428.55	$589.55	$1,426.36
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $137.62 / $137.62 / $636.65	Facility	26	$137.62	$137.62	$636.65
Univera Facility/Professional Professional Modifier Low / Median / High Price $613.64 / $837.88 / $1,569.19	Professional		$613.64	$837.88	$1,569.19
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $116.98 / $159.07 / $299.14	Professional	26	$116.98	$159.07	$299.14
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $496.66 / $678.81 / $1,270.05	Professional	TC	$496.66	$678.81	$1,270.05