Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $60.26 / $302.00	Facility		$26.92	$60.26	$302.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $74.13 / $234.42 / $478.63	Facility	25	$74.13	$234.42	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $53.70 / $123.03	Professional		$28.84	$53.70	$123.03
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $33.11 / $60.26 / $125.89	Professional	25	$33.11	$60.26	$125.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $70.79	Professional		$30.90	$52.48	$70.79
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $40.74 / $54.95 / $64.57	Professional	25	$40.74	$54.95	$64.57
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $363.08 / $398.11	Facility		$257.04	$363.08	$398.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $0.79 / $35.48 / $63.10	Professional		$0.79	$35.48	$63.10
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $51.29 / $128.82	Facility		$51.29	$51.29	$128.82
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $51.29 / $79.43	Professional		$51.29	$51.29	$79.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $67.61 / $245.47	Facility		$54.95	$67.61	$245.47
Cigna Facility/Professional Facility Modifier 22 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	22	$64.57	$64.57	$64.57
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $33.88 / $33.88 / $33.88	Facility	62	$33.88	$33.88	$33.88
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $5.37 / $5.37 / $5.37	Facility	AS	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $53.70 / $112.20	Professional		$30.20	$53.70	$112.20
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $34.67 / $67.61	Facility		$34.67	$34.67	$67.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $50.12 / $100.00	Professional		$42.66	$50.12	$100.00
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $35.48 / $36.31 / $63.10	Facility		$35.48	$36.31	$63.10
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $114.82	Professional		$37.15	$56.23	$114.82
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.02 / $85.11	Professional		$30.20	$38.02	$85.11
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $27.54 / $44.67 / $72.44	Professional	25	$27.54	$44.67	$72.44
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $141.25 / $245.47	Facility		$66.07	$141.25	$245.47
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $199.53 / $245.47	Facility	25	$50.12	$199.53	$245.47
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $57.54 / $117.49	Professional		$36.31	$57.54	$117.49
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $48.98 / $48.98 / $74.13	Professional	25	$48.98	$48.98	$74.13
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	50	$56.23	$56.23	$56.23
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $125.89	Professional		$51.29	$63.10	$125.89
Optum Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $56.23 / $79.43	Professional		$38.90	$56.23	$79.43
United Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $48.98 / $48.98	Facility		$48.98	$48.98	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $38.90 / $75.86	Professional		$21.88	$38.90	$75.86
Univera Facility/Professional Facility Modifier Low / Median / High Price $12.30 / $36.31 / $63.10	Facility		$12.30	$36.31	$63.10
Univera Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $60.26 / $95.50	Professional		$39.81	$60.26	$95.50