Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $154.88 / $295.12	Facility	26	$107.15	$154.88	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $794.33 / $1,905.46	Professional		$588.84	$794.33	$1,905.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $199.53 / $549.54	Professional	26	$114.82	$199.53	$549.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $371.54 / $1,258.93	Professional	52	$199.53	$371.54	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $660.69 / $1,348.96	Professional	TC	$467.74	$660.69	$1,348.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $588.84 / $676.08	Professional		$436.52	$588.84	$676.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $120.23 / $162.18	Professional	26	$112.20	$120.23	$162.18
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $141.25 / $141.25 / $141.25	Professional	52	$141.25	$141.25	$141.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $524.81 / $524.81	Professional	TC	$524.81	$524.81	$524.81
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $489.78 / $1,348.96	Professional		$380.19	$489.78	$1,348.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $245.47	Professional	26	$69.18	$87.10	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $389.05 / $1,047.13	Professional	TC	$316.23	$389.05	$1,047.13
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $724.44 / $912.01	Professional		$177.83	$724.44	$912.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $1,122.02 / $2,454.71	Professional		$588.84	$1,122.02	$2,454.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $208.93 / $446.68	Professional	26	$100.00	$208.93	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $912.01 / $2,089.30	Professional	TC	$436.52	$912.01	$2,089.30
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $676.08 / $1,412.54	Professional		$512.86	$676.08	$1,412.54
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $186.21 / $263.03	Professional	26	$131.83	$186.21	$263.03
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $912.01 / $1,202.26	Professional	TC	$645.65	$912.01	$1,202.26
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $794.33 / $1,380.38	Professional		$562.34	$794.33	$1,380.38
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $151.36 / $257.04	Professional	26	$107.15	$151.36	$257.04
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $645.65 / $1,096.48	Professional	TC	$457.09	$645.65	$1,096.48
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $724.44 / $724.44	Professional		$707.95	$724.44	$724.44
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $144.54 / $302.00	Professional	26	$141.25	$144.54	$302.00
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $354.81 / $354.81 / $363.08	Professional	52	$354.81	$354.81	$363.08
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $891.25 / $1,698.24	Professional		$741.31	$891.25	$1,698.24
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $173.78 / $323.59	Professional	26	$141.25	$173.78	$323.59
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $707.95 / $1,380.38	Professional	TC	$588.84	$707.95	$1,380.38
United Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $758.58 / $1,778.28	Professional		$562.34	$758.58	$1,778.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $338.84	Professional	26	$102.33	$144.54	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $616.60 / $1,445.44	Professional	TC	$446.68	$616.60	$1,445.44
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $144.54 / $691.83	Facility	26	$100.00	$144.54	$691.83
Univera Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $794.33 / $1,819.70	Professional		$524.81	$794.33	$1,819.70
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $151.36 / $346.74	Professional	26	$100.00	$151.36	$346.74
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $645.65 / $1,412.54	Professional	TC	$426.58	$645.65	$1,412.54