Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.38 / $89.25 / $284.00	Facility		$68.38	$89.25	$284.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $50.00 / $50.00 / $50.00	Facility	25	$50.00	$50.00	$50.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.76 / $69.20 / $102.38	Professional		$51.76	$69.20	$102.38
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $94.39 / $94.39 / $94.39	Professional	25	$94.39	$94.39	$94.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.87 / $65.68 / $79.30	Professional		$57.87	$65.68	$79.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.00 / $15.00 / $306.00	Facility		$15.00	$15.00	$306.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.80 / $49.89 / $84.89	Professional		$0.80	$49.89	$84.89
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $53.81 / $53.81 / $89.76	Facility		$53.81	$53.81	$89.76
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $53.81 / $54.23 / $100.27	Professional		$53.81	$54.23	$100.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.00 / $84.00 / $110.34	Facility		$23.00	$84.00	$110.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.00 / $73.48 / $192.54	Professional		$30.00	$73.48	$192.54
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $14.00 / $14.00 / $319.00	Facility		$14.00	$14.00	$319.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $73.40 / $93.16 / $141.08	Professional		$73.40	$93.16	$141.08
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $15.75 / $20.56 / $61.05	Facility		$15.75	$20.56	$61.05
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.02 / $74.61 / $129.78	Professional		$46.02	$74.61	$129.78
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $34.65 / $37.79 / $84.62	Professional		$34.65	$37.79	$84.62
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $147.47 / $245.52 / $303.58	Facility		$147.47	$245.52	$303.58
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.90 / $74.80 / $78.16	Professional		$62.90	$74.80	$78.16
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $23.00 / $84.00 / $110.34	Facility		$23.00	$84.00	$110.34
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $76.09 / $171.18	Professional		$28.00	$76.09	$171.18
Optum Facility/Professional Professional Modifier Low / Median / High Price $39.25 / $72.59 / $93.89	Professional		$39.25	$72.59	$93.89
United Facility/Professional Professional Modifier Low / Median / High Price $47.57 / $74.97 / $155.82	Professional		$47.57	$74.97	$155.82
Univera Facility/Professional Facility Modifier Low / Median / High Price $19.62 / $20.56 / $78.52	Facility		$19.62	$20.56	$78.52
Univera Facility/Professional Professional Modifier Low / Median / High Price $65.98 / $75.31 / $165.97	Professional		$65.98	$75.31	$165.97