Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $169.82 / $524.81	Facility	26	$134.90	$169.82	$524.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $288.40 / $758.58	Professional		$204.17	$288.40	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $151.36 / $407.38	Professional	26	$117.49	$151.36	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $93.33 / $186.21	Professional	TC	$75.86	$93.33	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $204.17 / $245.47	Professional		$186.21	$204.17	$245.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $165.96 / $177.83	Professional	26	$147.91	$165.96	$177.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $190.55 / $416.87	Professional		$154.88	$190.55	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $109.65 / $245.47	Professional	26	$87.10	$109.65	$245.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $177.83	Professional	TC	$66.07	$83.18	$177.83
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $323.59	Professional		$131.83	$190.55	$323.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $346.74 / $977.24	Professional		$181.97	$346.74	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $199.53 / $524.81	Professional	26	$102.33	$199.53	$524.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $151.36 / $363.08	Professional	TC	$75.86	$151.36	$363.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $338.84 / $457.09	Professional		$229.09	$338.84	$457.09
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $199.53 / $281.84	Professional	26	$134.90	$199.53	$281.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $181.97	Professional	TC	$95.50	$138.04	$181.97
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $208.93 / $446.68	Professional		$147.91	$208.93	$446.68
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $275.42	Professional	26	$104.71	$131.83	$275.42
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $83.18 / $173.78	Professional	TC	$56.23	$83.18	$173.78
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	26	$190.55	$190.55	$190.55
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $251.19 / $257.04	Professional		$229.09	$251.19	$257.04
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $151.36 / $275.42	Professional	26	$123.03	$151.36	$275.42
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $562.34	Professional		$263.03	$316.23	$562.34
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $186.21 / $346.74	Professional	26	$151.36	$186.21	$346.74
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $131.83 / $218.78	Professional	TC	$107.15	$131.83	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $251.19 / $630.96	Professional		$186.21	$251.19	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $147.91 / $363.08	Professional	26	$109.65	$147.91	$363.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $269.15	Professional	TC	$77.62	$107.15	$269.15
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $151.36 / $239.88	Facility	26	$83.18	$151.36	$239.88
Univera Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $223.87 / $537.03	Professional		$165.96	$223.87	$537.03
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $151.36 / $331.13	Professional	26	$104.71	$151.36	$331.13
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $204.17	Professional	TC	$61.66	$93.33	$204.17