Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.15 / $148.04 / $284.60	Facility	26	$108.15	$148.04	$284.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $584.29 / $777.87 / $1,643.46	Professional		$584.29	$777.87	$1,643.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.16 / $137.65 / $343.80	Professional	26	$108.16	$137.65	$343.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $290.17 / $338.22 / $495.64	Professional	52	$290.17	$338.22	$495.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $476.13 / $641.35 / $1,163.21	Professional	TC	$476.13	$641.35	$1,163.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $635.89 / $635.89 / $635.89	Professional		$635.89	$635.89	$635.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $119.25 / $119.25 / $119.25	Professional	26	$119.25	$119.25	$119.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $384.53 / $502.66 / $1,455.98	Professional		$384.53	$502.66	$1,455.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.95 / $90.15 / $244.78	Professional	26	$68.95	$90.15	$244.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $315.57 / $412.51 / $1,121.81	Professional	TC	$315.57	$412.51	$1,121.81
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $177.30 / $724.41 / $901.70	Professional		$177.30	$724.41	$901.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $510.70 / $1,123.83 / $2,255.98	Professional		$510.70	$1,123.83	$2,255.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.16 / $205.80 / $413.53	Professional	26	$92.16	$205.80	$413.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $418.54 / $905.11 / $1,867.45	Professional	TC	$418.54	$905.11	$1,867.45
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $512.59 / $719.37 / $1,277.40	Professional		$512.59	$719.37	$1,277.40
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $136.10 / $166.33 / $249.98	Professional	26	$136.10	$166.33	$249.98
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $633.72 / $822.16 / $1,094.60	Professional	TC	$633.72	$822.16	$1,094.60
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $563.42 / $813.64 / $1,482.52	Professional		$563.42	$813.64	$1,482.52
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $106.86 / $153.71 / $281.17	Professional	26	$106.86	$153.71	$281.17
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $456.57 / $659.93 / $1,201.34	Professional	TC	$456.57	$659.93	$1,201.34
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $639.89 / $639.89 / $639.89	Professional		$639.89	$639.89	$639.89
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $653.02 / $711.14 / $711.14	Professional		$653.02	$711.14	$711.14
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.62 / $142.22 / $294.79	Professional	26	$130.62	$142.22	$294.79
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $355.57 / $355.57 / $355.57	Professional	52	$355.57	$355.57	$355.57
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $637.66 / $1,030.86 / $2,223.92	Professional		$637.66	$1,030.86	$2,223.92
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $100.42 / $191.98 / $399.28	Professional	26	$100.42	$191.98	$399.28
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $505.41 / $823.23 / $1,768.97	Professional	TC	$505.41	$823.23	$1,768.97
United Facility/Professional Professional Modifier Low / Median / High Price $558.21 / $765.08 / $1,718.13	Professional		$558.21	$765.08	$1,718.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.06 / $145.00 / $339.17	Professional	26	$108.06	$145.00	$339.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $454.50 / $616.32 / $1,451.34	Professional	TC	$454.50	$616.32	$1,451.34
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $143.12 / $143.12 / $685.11	Facility	26	$143.12	$143.12	$685.11
Univera Facility/Professional Professional Modifier Low / Median / High Price $641.41 / $877.39 / $1,640.21	Professional		$641.41	$877.39	$1,640.21
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $121.65 / $165.76 / $311.08	Professional	26	$121.65	$165.76	$311.08
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $519.77 / $711.64 / $1,329.13	Professional	TC	$519.77	$711.64	$1,329.13