Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.96 / $212.09 / $493.69	Facility		$137.96	$212.09	$493.69
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $281.75 / $482.82 / $984.18	Facility	25	$281.75	$482.82	$984.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.94 / $212.09 / $556.01	Professional		$129.94	$212.09	$556.01
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $125.35 / $262.11 / $740.50	Professional	25	$125.35	$262.11	$740.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $172.09 / $216.88 / $307.79	Professional		$172.09	$216.88	$307.79
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $199.63 / $224.04 / $334.73	Professional	25	$199.63	$224.04	$334.73
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 / $151.72 / $347.12	Professional		$0.80	$151.72	$347.12
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $260.16 / $260.16 / $574.00	Facility		$260.16	$260.16	$574.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $260.16 / $260.16 / $311.73	Professional		$260.16	$260.16	$311.73
Cigna Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $242.44 / $265.00	Facility		$150.00	$242.44	$265.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.41 / $265.43 / $524.91	Professional		$159.41	$265.43	$524.91
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $221.09 / $332.00	Facility		$35.00	$221.09	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $89.79 / $125.49 / $395.47	Professional		$89.79	$125.49	$395.47
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $50.59 / $75.00 / $208.14	Facility		$50.59	$75.00	$208.14
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $171.04 / $233.11 / $409.41	Professional		$171.04	$233.11	$409.41
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $159.00 / $218.63 / $270.07	Professional		$159.00	$218.63	$270.07
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $179.89 / $218.63 / $221.09	Professional	25	$179.89	$218.63	$221.09
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $952.56 / $952.56 / $952.56	Facility		$952.56	$952.56	$952.56
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $214.12 / $261.39 / $369.03	Professional		$214.12	$261.39	$369.03
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $219.11 / $256.36 / $342.11	Professional	25	$219.11	$256.36	$342.11
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $242.44 / $265.13	Facility		$150.00	$242.44	$265.13
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $159.41 / $274.94 / $529.92	Professional		$159.41	$274.94	$529.92
Optum Facility/Professional Professional Modifier Low / Median / High Price $93.28 / $231.66 / $314.57	Professional		$93.28	$231.66	$314.57
United Facility/Professional Professional Modifier Low / Median / High Price $123.61 / $224.03 / $447.48	Professional		$123.61	$224.03	$447.48
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $88.00 / $88.00	Professional	25	$80.00	$88.00	$88.00
Univera Facility/Professional Facility Modifier Low / Median / High Price $50.59 / $82.86 / $247.68	Facility		$50.59	$82.86	$247.68
Univera Facility/Professional Professional Modifier Low / Median / High Price $185.70 / $247.76 / $460.14	Professional		$185.70	$247.76	$460.14