Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.25 / $132.07 / $189.20	Facility	26	$92.25	$132.07	$189.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.50 / $198.72 / $573.00	Professional		$165.50	$198.72	$573.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.25 / $110.56 / $248.20	Professional	26	$92.25	$110.56	$248.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.20 / $79.70 / $131.94	Professional	TC	$68.20	$79.70	$131.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $142.01 / $168.52 / $186.00	Professional		$142.01	$168.52	$186.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $101.31 / $101.31 / $112.88	Professional	26	$101.31	$101.31	$112.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.66 / $165.74 / $358.86	Professional		$129.66	$165.74	$358.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.45 / $92.10 / $200.37	Professional	26	$70.45	$92.10	$200.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.21 / $73.53 / $156.94	Professional	TC	$59.21	$73.53	$156.94
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $114.49 / $152.07 / $266.56	Professional		$114.49	$152.07	$266.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.49 / $272.58 / $648.73	Professional		$125.49	$272.58	$648.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.81 / $158.76 / $360.32	Professional	26	$77.81	$158.76	$360.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.91 / $137.08 / $290.85	Professional	TC	$60.91	$137.08	$290.85
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $182.21 / $237.36 / $351.65	Professional		$182.21	$237.36	$351.65
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.03 / $141.61 / $211.92	Professional	26	$107.03	$141.61	$211.92
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.70 / $107.14 / $142.84	Professional	TC	$82.70	$107.14	$142.84
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.30 / $174.21 / $402.65	Professional		$143.30	$174.21	$402.65
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.68 / $106.04 / $239.86	Professional	26	$84.68	$106.04	$239.86
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.94 / $73.73 / $162.79	Professional	TC	$57.94	$73.73	$162.79
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $134.34 / $139.13 / $151.91	Professional		$134.34	$139.13	$151.91
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.05 / $210.66 / $256.16	Professional		$162.05	$210.66	$256.16
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $108.07 / $120.07 / $217.88	Professional	26	$108.07	$120.07	$217.88
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $127.41 / $250.51 / $587.26	Professional		$127.41	$250.51	$587.26
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $83.48 / $153.16 / $346.14	Professional	26	$83.48	$153.16	$346.14
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $68.01 / $124.84 / $281.49	Professional	TC	$68.01	$124.84	$281.49
United Facility/Professional Professional Modifier Low / Median / High Price $162.05 / $213.76 / $488.06	Professional		$162.05	$213.76	$488.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $94.17 / $122.08 / $290.35	Professional	26	$94.17	$122.08	$290.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.23 / $96.76 / $236.14	Professional	TC	$72.23	$96.76	$236.14
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $122.09 / $122.09 / $226.80	Facility	26	$122.09	$122.09	$226.80
Univera Facility/Professional Professional Modifier Low / Median / High Price $146.94 / $207.02 / $448.02	Professional		$146.94	$207.02	$448.02
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $84.68 / $124.76 / $266.88	Professional	26	$84.68	$124.76	$266.88
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $62.25 / $82.86 / $181.13	Professional	TC	$62.25	$82.86	$181.13