Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.58 / $3,023.04 / $8,402.78	Facility		$199.58	$3,023.04	$8,402.78
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $313.19 / $4,253.64 / $8,907.99	Facility	50	$313.19	$4,253.64	$8,907.99
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $25.37 / $49.33 / $87.94	Facility	53	$25.37	$49.33	$87.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.02 / $251.19 / $798.46	Professional		$104.02	$251.19	$798.46
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $136.01 / $359.24 / $2,185.21	Professional	50	$136.01	$359.24	$2,185.21
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $21.33 / $46.06 / $82.06	Professional	53	$21.33	$46.06	$82.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $231.08 / $231.08 / $308.31	Professional		$231.08	$231.08	$308.31
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $162.63 / $162.63 / $162.63	Professional	50	$162.63	$162.63	$162.63
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,689.00 / $3,373.00 / $4,707.00	Facility		$1,689.00	$3,373.00	$4,707.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $149.81 / $195.58 / $604.42	Professional		$149.81	$195.58	$604.42
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $233.45 / $296.07 / $890.53	Professional	50	$233.45	$296.07	$890.53
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $157.72 / $1,254.00 / $4,050.00	Facility		$157.72	$1,254.00	$4,050.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $157.72 / $157.72 / $352.52	Professional		$157.72	$157.72	$352.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $188.07 / $188.07 / $188.07	Facility		$188.07	$188.07	$188.07
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.65 / $291.07 / $827.59	Professional		$115.65	$291.07	$827.59
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $105.00 / $170.10 / $332.00	Facility		$105.00	$170.10	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $271.66 / $413.76 / $1,569.11	Professional		$271.66	$413.76	$1,569.11
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $226.10 / $226.10 / $226.10	Facility		$226.10	$226.10	$226.10
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.34 / $274.38 / $519.70	Professional		$200.34	$274.38	$519.70
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $159.32 / $159.32 / $159.32	Professional		$159.32	$159.32	$159.32
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $909.07 / $1,855.10 / $3,270.78	Facility		$909.07	$1,855.10	$3,270.78
Highmark BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $1,362.29 / $3,769.07 / $4,906.18	Facility	50	$1,362.29	$3,769.07	$4,906.18
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.51 / $162.51 / $337.99	Professional		$162.51	$162.51	$337.99
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $352.13 / $506.99 / $512.57	Professional	50	$352.13	$506.99	$512.57
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $188.07 / $555.00 / $597.00	Facility		$188.07	$555.00	$597.00
MVP Health Care Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $131.50 / $310.13 / $844.54	Professional		$131.50	$310.13	$844.54
MVP Health Care Facility/Professional Professional Modifier 53 Low / Median / High Price $125.08 / $163.47 / $252.93	Professional	53	$125.08	$163.47	$252.93
United Facility/Professional Facility Modifier Low / Median / High Price $1,348.00 / $3,496.00 / $6,201.00	Facility		$1,348.00	$3,496.00	$6,201.00
United Facility/Professional Professional Modifier Low / Median / High Price $209.43 / $329.77 / $745.24	Professional		$209.43	$329.77	$745.24
Univera Facility/Professional Facility Modifier Low / Median / High Price $129.66 / $129.66 / $509.85	Facility		$129.66	$129.66	$509.85
Univera Facility/Professional Professional Modifier Low / Median / High Price $226.10 / $299.56 / $519.70	Professional		$226.10	$299.56	$519.70