Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.61 / $76.39 / $299.77	Facility		$38.61	$76.39	$299.77
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $91.13 / $281.75 / $481.28	Facility	25	$91.13	$281.75	$481.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.29 / $70.14 / $159.59	Professional		$39.29	$70.14	$159.59
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $55.51 / $86.47 / $226.30	Professional	25	$55.51	$86.47	$226.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.82 / $71.54 / $108.58	Professional		$46.82	$71.54	$108.58
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $62.50 / $68.18 / $130.05	Professional	25	$62.50	$68.18	$130.05
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.00 / $150.00 / $198.00	Facility		$83.00	$150.00	$198.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.80 / $62.79 / $123.38	Professional		$0.80	$62.79	$123.38
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $69.45 / $69.45 / $264.00	Facility		$69.45	$69.45	$264.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $69.45 / $69.45 / $102.40	Professional		$69.45	$69.45	$102.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $62.64 / $62.64 / $185.00	Facility		$62.64	$62.64	$185.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.75 / $87.24 / $172.91	Professional		$48.75	$87.24	$172.91
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $57.23 / $332.00	Facility		$35.00	$57.23	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $67.59 / $84.50 / $133.69	Professional		$67.59	$84.50	$133.69
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $39.11 / $58.24 / $67.34	Facility		$39.11	$58.24	$67.34
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.71 / $75.43 / $133.88	Professional		$56.71	$75.43	$133.88
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $55.89 / $79.54 / $87.49	Professional		$55.89	$79.54	$87.49
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $57.27 / $87.22 / $87.49	Professional	25	$57.27	$87.22	$87.49
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.00 / $80.81 / $170.12	Professional		$64.00	$80.81	$170.12
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $80.13 / $94.27 / $173.19	Professional	25	$80.13	$94.27	$173.19
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $62.64 / $62.64 / $265.00	Facility		$62.64	$62.64	$265.00
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $50.46 / $94.17 / $182.94	Professional		$50.46	$94.17	$182.94
Optum Facility/Professional Professional Modifier Low / Median / High Price $36.25 / $80.15 / $101.75	Professional		$36.25	$80.15	$101.75
United Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $81.65 / $170.01	Professional		$54.00	$81.65	$170.01
Univera Facility/Professional Facility Modifier Low / Median / High Price $24.67 / $58.24 / $105.76	Facility		$24.67	$58.24	$105.76
Univera Facility/Professional Professional Modifier Low / Median / High Price $59.12 / $81.02 / $133.88	Professional		$59.12	$81.02	$133.88