Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.62 / $166.07 / $347.94	Facility	26	$126.62	$166.07	$347.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.81 / $240.88 / $562.41	Professional		$199.81	$240.88	$562.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.15 / $138.21 / $259.72	Professional	26	$115.15	$138.21	$259.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.39 / $92.39 / $148.97	Professional	TC	$78.39	$92.39	$148.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.77 / $189.74 / $263.48	Professional		$170.77	$189.74	$263.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $126.85 / $126.85 / $134.97	Professional	26	$126.85	$126.85	$134.97
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.68 / $200.36 / $428.15	Professional		$154.68	$200.36	$428.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.89 / $114.90 / $250.29	Professional	26	$87.89	$114.90	$250.29
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.78 / $83.94 / $180.02	Professional	TC	$66.78	$83.94	$180.02
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $131.19 / $188.91 / $320.10	Professional		$131.19	$188.91	$320.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.47 / $324.33 / $784.96	Professional		$151.47	$324.33	$784.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.82 / $197.52 / $446.70	Professional	26	$96.82	$197.52	$446.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.98 / $156.13 / $334.87	Professional	TC	$69.98	$156.13	$334.87
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $218.61 / $284.80 / $422.26	Professional		$218.61	$284.80	$422.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $133.77 / $176.77 / $264.54	Professional	26	$133.77	$176.77	$264.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.32 / $120.89 / $161.19	Professional	TC	$93.32	$120.89	$161.19
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.90 / $209.19 / $485.81	Professional		$172.90	$209.19	$485.81
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.91 / $139.59 / $299.63	Professional	26	$104.91	$139.59	$299.63
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $83.22 / $186.18	Professional	TC	$66.26	$83.22	$186.18
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $161.31 / $196.56 / $196.56	Professional		$161.31	$196.56	$196.56
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.76 / $249.74 / $256.50	Professional		$229.76	$249.74	$256.50
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $121.91 / $150.03 / $270.05	Professional	26	$121.91	$150.03	$270.05
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $153.10 / $300.18 / $703.92	Professional		$153.10	$300.18	$703.92
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $104.08 / $189.87 / $425.20	Professional	26	$104.08	$189.87	$425.20
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $76.75 / $141.68 / $322.22	Professional	TC	$76.75	$141.68	$322.22
United Facility/Professional Professional Modifier Low / Median / High Price $199.09 / $260.25 / $606.26	Professional		$199.09	$260.25	$606.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $116.50 / $154.47 / $377.87	Professional	26	$116.50	$154.47	$377.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.38 / $108.14 / $270.39	Professional	TC	$77.38	$108.14	$270.39
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $152.51 / $152.51 / $283.79	Facility	26	$152.51	$152.51	$283.79
Univera Facility/Professional Professional Modifier Low / Median / High Price $176.44 / $248.59 / $540.54	Professional		$176.44	$248.59	$540.54
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $106.64 / $155.74 / $333.39	Professional	26	$106.64	$155.74	$333.39
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $71.53 / $94.76 / $207.16	Professional	TC	$71.53	$94.76	$207.16