Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $17.29 / $37.90	Facility	26	$11.48	$17.29	$37.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.61 / $124.05 / $289.56	Facility	TC	$38.61	$124.05	$289.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.84 / $54.25 / $108.46	Professional		$37.84	$54.25	$108.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.04 / $34.04	Professional	26	$11.48	$15.04	$34.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.36 / $36.45 / $75.20	Professional	TC	$26.36	$36.45	$75.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $40.40 / $48.74	Professional		$35.11	$40.40	$48.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.74 / $10.99 / $19.95	Professional	26	$7.74	$10.99	$19.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.35 / $54.71 / $131.63	Professional		$42.35	$54.71	$131.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.44 / $13.65 / $33.29	Professional	26	$10.44	$13.65	$33.29
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $63.52 / $78.88 / $177.06	Professional	50	$63.52	$78.88	$177.06
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.90 / $39.61 / $83.20	Professional	TC	$31.90	$39.61	$83.20
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $20.60 / $54.33 / $74.93	Professional		$20.60	$54.33	$74.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.08 / $71.93 / $163.00	Professional		$40.08	$71.93	$163.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.59 / $20.01 / $42.64	Professional	26	$10.59	$20.01	$42.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.14 / $53.09 / $120.43	Professional	TC	$30.14	$53.09	$120.43
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $50.07 / $65.65 / $110.15	Professional		$50.07	$65.65	$110.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.30 / $18.17 / $29.26	Professional	26	$13.30	$18.17	$29.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.83 / $53.32 / $85.66	Professional	TC	$40.83	$53.32	$85.66
Excellus BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $8.93 / $8.93 / $8.93	Facility	TC	$8.93	$8.93	$8.93
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.73 / $63.39 / $113.61	Professional		$41.73	$63.39	$113.61
Excellus BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $12.11 / $18.62 / $30.18	Professional	26	$12.11	$18.62	$30.18
Excellus BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.65 / $46.55 / $83.43	Professional	TC	$28.65	$46.55	$83.43
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $55.41 / $57.45 / $58.98	Professional		$55.41	$57.45	$58.98
Fidelis Facility/Professional Professional Modifier 26 Low / Median / High Price $11.97 / $11.97 / $11.97	Professional	26	$11.97	$11.97	$11.97
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $36.84 / $104.26 / $415.52	Facility	TC	$36.84	$104.26	$415.52
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.23 / $57.87 / $81.86	Professional		$53.23	$57.87	$81.86
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $17.09 / $29.82	Professional	26	$16.80	$17.09	$29.82
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $53.82 / $53.82 / $53.82	Professional	50	$53.82	$53.82	$53.82
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.61 / $55.61 / $55.61	Professional	TC	$55.61	$55.61	$55.61
MVP Health Care Facility/Professional Facility Modifier 26 Low / Median / High Price $16.14 / $16.14 / $16.14	Facility	26	$16.14	$16.14	$16.14
MVP Health Care Facility/Professional Facility Modifier TC Low / Median / High Price $44.74 / $44.74 / $44.74	Facility	TC	$44.74	$44.74	$44.74
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $42.55 / $71.31 / $149.33	Professional		$42.55	$71.31	$149.33
MVP Health Care Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $19.39 / $41.29	Professional	26	$11.21	$19.39	$41.29
MVP Health Care Facility/Professional Professional Modifier TC Low / Median / High Price $30.16 / $50.06 / $108.96	Professional	TC	$30.16	$50.06	$108.96
United Facility/Professional Professional Modifier Low / Median / High Price $41.64 / $52.14 / $111.01	Professional		$41.64	$52.14	$111.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.91 / $15.18 / $32.99	Professional	26	$11.91	$15.18	$32.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.12 / $39.40 / $82.68	Professional	TC	$31.12	$39.40	$82.68
Univera Facility/Professional Facility Modifier 26 Low / Median / High Price $16.55 / $16.55 / $27.10	Facility	26	$16.55	$16.55	$27.10
Univera Facility/Professional Facility Modifier TC Low / Median / High Price $45.78 / $45.78 / $57.36	Facility	TC	$45.78	$45.78	$57.36
Univera Facility/Professional Professional Modifier Low / Median / High Price $41.73 / $79.53 / $136.91	Professional		$41.73	$79.53	$136.91
Univera Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $21.13 / $36.36	Professional	26	$12.86	$21.13	$36.36
Univera Facility/Professional Professional Modifier TC Low / Median / High Price $28.87 / $58.39 / $100.54	Professional	TC	$28.87	$58.39	$100.54