Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.62 / $81.14 / $422.38	Facility		$25.62	$81.14	$422.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.46 / $12.08 / $24.64	Facility	26	$8.46	$12.08	$24.64
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.11 / $89.67 / $236.28	Facility	TC	$22.11	$89.67	$236.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.86 / $43.83 / $108.44	Professional		$25.86	$43.83	$108.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $12.15 / $29.88	Professional	26	$8.52	$12.15	$29.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.16 / $28.54 / $69.14	Professional	TC	$17.16	$28.54	$69.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.87 / $35.17 / $40.10	Professional		$25.87	$35.17	$40.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $8.36 / $15.84	Professional	26	$7.83	$8.36	$15.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.32 / $38.33 / $96.01	Professional		$29.32	$38.33	$96.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $7.51 / $9.82 / $25.46	Professional	26	$7.51	$9.82	$25.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.81 / $27.63 / $61.18	Professional	TC	$21.81	$27.63	$61.18
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $15.67 / $15.67 / $39.53	Facility		$15.67	$15.67	$39.53
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $15.67 / $39.53 / $55.20	Professional		$15.67	$39.53	$55.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $58.69 / $94.34 / $204.70	Facility		$58.69	$94.34	$204.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.60 / $54.12 / $135.44	Professional		$30.60	$54.12	$135.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.27 / $15.06 / $32.61	Professional	26	$8.27	$15.06	$32.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.39 / $39.95 / $104.30	Professional	TC	$21.39	$39.95	$104.30
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $24.62 / $44.20 / $332.00	Facility		$24.62	$44.20	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $36.75 / $46.70 / $80.84	Professional		$36.75	$46.70	$80.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.11 / $13.91 / $22.26	Professional	26	$10.11	$13.91	$22.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.62 / $38.63 / $62.22	Professional	TC	$29.62	$38.63	$62.22
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.15 / $15.15 / $15.15	Facility		$15.15	$15.15	$15.15
Excellus BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $9.09 / $9.09 / $9.09	Facility	TC	$9.09	$9.09	$9.09
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $46.53 / $83.40	Professional		$26.52	$46.53	$83.40
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $14.16 / $22.95	Professional	26	$6.46	$14.16	$22.95
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.98 / $33.72 / $60.44	Professional	TC	$19.98	$33.72	$60.44
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $42.99 / $73.94	Professional		$40.72	$42.99	$73.94
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $7.95 / $7.95	Professional	26	$7.95	$7.95	$7.95
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $32.10 / $118.01 / $247.13	Facility		$32.10	$118.01	$247.13
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $26.64 / $72.42 / $272.61	Facility	TC	$26.64	$72.42	$272.61
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.65 / $42.53 / $95.12	Professional		$38.65	$42.53	$95.12
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.29 / $13.68 / $22.66	Professional	26	$12.29	$13.68	$22.66
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.35 / $68.98 / $68.98	Professional	TC	$43.35	$68.98	$68.98
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $94.42 / $254.50	Facility		$50.00	$94.42	$254.50
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $32.44 / $32.44 / $32.44	Facility	TC	$32.44	$32.44	$32.44
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $32.17 / $53.28 / $120.90	Professional		$32.17	$53.28	$120.90
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $14.62 / $31.78	Professional	26	$8.64	$14.62	$31.78
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $22.15 / $35.47 / $90.81	Professional	TC	$22.15	$35.47	$90.81
United Facility/Professional Professional Modifier Low / Median / High Price $31.27 / $40.03 / $89.36	Professional		$31.27	$40.03	$89.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.81 / $12.05 / $24.80	Professional	26	$8.81	$12.05	$24.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.27 / $28.69 / $74.03	Professional	TC	$22.27	$28.69	$74.03
Univera Facility/Professional Facility Modifier Low / Median / High Price $45.76 / $45.76 / $104.88	Facility		$45.76	$45.76	$104.88
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $12.60 / $12.60 / $35.18	Facility	26	$12.60	$12.60	$35.18
Univera Facility/Professional Facility Modifier TC Low / Median / High Price $33.17 / $33.17 / $76.42	Facility	TC	$33.17	$33.17	$76.42
Univera Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $58.38 / $103.41	Professional		$26.52	$58.38	$103.41
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $16.07 / $28.84	Professional	26	$6.46	$16.07	$28.84
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $42.31 / $76.09	Professional	TC	$20.07	$42.31	$76.09