Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.62 / $197.73 / $355.31	Facility	26	$136.62	$197.73	$355.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.72 / $272.14 / $665.13	Professional		$226.72	$272.14	$665.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $136.62 / $161.04 / $272.10	Professional	26	$136.62	$161.04	$272.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $104.53 / $165.56	Professional	TC	$87.95	$104.53	$165.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.46 / $264.07 / $307.77	Professional		$199.46	$264.07	$307.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $197.70 / $197.70 / $197.70	Professional	26	$197.70	$197.70	$197.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.55 / $234.98 / $490.04	Professional		$185.55	$234.98	$490.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.20 / $140.99 / $298.89	Professional	26	$111.20	$140.99	$298.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.34 / $92.33 / $195.88	Professional	TC	$74.34	$92.33	$195.88
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $144.46 / $226.01 / $370.48	Professional		$144.46	$226.01	$370.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $176.41 / $176.41 / $176.41	Facility	26	$176.41	$176.41	$176.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.43 / $359.04 / $910.66	Professional		$177.43	$359.04	$910.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.14 / $236.90 / $535.41	Professional	26	$116.14	$236.90	$535.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.69 / $167.80 / $371.95	Professional	TC	$78.69	$167.80	$371.95
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $254.70 / $332.02 / $492.07	Professional		$254.70	$332.02	$492.07
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $160.13 / $211.50 / $316.52	Professional	26	$160.13	$211.50	$316.52
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.01 / $134.85 / $179.65	Professional	TC	$104.01	$134.85	$179.65
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $202.17 / $243.77 / $568.04	Professional		$202.17	$243.77	$568.04
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $124.85 / $167.00 / $357.90	Professional	26	$124.85	$167.00	$357.90
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.79 / $92.99 / $210.15	Professional	TC	$74.79	$92.99	$210.15
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $212.21 / $228.92 / $234.55	Professional		$212.21	$228.92	$234.55
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $262.99 / $289.06 / $595.28	Professional		$262.99	$289.06	$595.28
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $178.00 / $178.00 / $321.79	Professional	26	$178.00	$178.00	$321.79
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $176.41 / $176.41 / $176.41	Facility	26	$176.41	$176.41	$176.41
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $178.01 / $343.54 / $812.04	Professional		$178.01	$343.54	$812.04
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $123.63 / $226.52 / $506.64	Professional	26	$123.63	$226.52	$506.64
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $84.87 / $153.00 / $348.57	Professional	TC	$84.87	$153.00	$348.57
United Facility/Professional Professional Modifier Low / Median / High Price $215.43 / $292.80 / $694.30	Professional		$215.43	$292.80	$694.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.51 / $182.87 / $428.83	Professional	26	$138.51	$182.87	$428.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.75 / $122.36 / $325.01	Professional	TC	$88.75	$122.36	$325.01
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $182.17 / $182.17 / $340.54	Facility	26	$182.17	$182.17	$340.54
Univera Facility/Professional Professional Modifier Low / Median / High Price $205.22 / $289.68 / $632.04	Professional		$205.22	$289.68	$632.04
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $127.38 / $186.33 / $398.23	Professional	26	$127.38	$186.33	$398.23
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $80.38 / $106.97 / $233.83	Professional	TC	$80.38	$106.97	$233.83