Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $165.96 / $489.78	Facility		$100.00	$165.96	$489.78
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $213.80 / $436.52 / $933.25	Facility	25	$213.80	$436.52	$933.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $446.68	Professional		$107.15	$181.97	$446.68
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $123.03 / $204.17 / $501.19	Professional	25	$123.03	$204.17	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $162.18 / $218.78	Professional		$114.82	$162.18	$218.78
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $134.90 / $165.96 / $213.80	Professional	25	$134.90	$165.96	$213.80
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $912.01 / $977.24	Facility		$812.83	$912.01	$977.24
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.79 / $109.65 / $213.80	Professional		$0.79	$109.65	$213.80
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $234.42	Professional		$190.55	$190.55	$234.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $204.17 / $245.47	Facility		$144.54	$204.17	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $194.98 / $380.19	Professional		$128.82	$194.98	$380.19
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $34.67 / $199.53	Facility		$34.67	$34.67	$199.53
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $91.20 / $295.12	Professional		$81.28	$91.20	$295.12
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $45.71 / $186.21	Facility		$36.31	$45.71	$186.21
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $169.82 / $338.84	Professional		$120.23	$169.82	$338.84
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $173.78 / $213.80	Professional		$93.33	$173.78	$213.80
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $144.54 / $162.18 / $263.03	Professional	25	$144.54	$162.18	$263.03
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $281.84 / $724.44	Facility		$281.84	$281.84	$724.44
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $575.44 / $575.44 / $724.44	Facility	25	$575.44	$575.44	$724.44
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $269.15	Professional		$173.78	$213.80	$269.15
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $177.83 / $213.80 / $263.03	Professional	25	$177.83	$213.80	$263.03
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $371.54	Professional		$177.83	$229.09	$371.54
Optum Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $181.97 / $239.88	Professional		$75.86	$181.97	$239.88
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $131.83	Facility		$69.18	$69.18	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $154.88 / $288.40	Professional		$93.33	$154.88	$288.40
Univera Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $109.65 / $199.53	Facility		$36.31	$109.65	$199.53
Univera Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $309.03	Professional		$128.82	$177.83	$309.03