Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $49.33 / $90.39 / $366.85	Facility		$49.33	$90.39	$366.85
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $59.10 / $246.52 / $469.65	Facility	25	$59.10	$246.52	$469.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.05 / $79.89 / $192.00	Professional		$43.05	$79.89	$192.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $26.00 / $88.69 / $227.35	Professional	25	$26.00	$88.69	$227.35
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.13 / $86.34 / $109.36	Professional		$62.13	$86.34	$109.36
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $66.18 / $91.52 / $117.14	Professional	25	$66.18	$91.52	$117.14
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 / $59.51 / $128.86	Professional		$0.80	$59.51	$128.86
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $95.01 / $95.01 / $391.00	Facility		$95.01	$95.01	$391.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $95.01 / $95.01 / $128.43	Professional		$95.01	$95.01	$128.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $88.08 / $231.49	Facility		$88.08	$88.08	$231.49
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.22 / $93.74 / $191.98	Professional		$53.22	$93.74	$191.98
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $80.50 / $332.00	Facility		$35.00	$80.50	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.75 / $89.04 / $157.12	Professional		$42.75	$89.04	$157.12
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $37.22 / $55.40 / $85.86	Facility		$37.22	$55.40	$85.86
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.53 / $96.16 / $168.87	Professional		$62.53	$96.16	$168.87
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $57.52 / $80.40 / $113.71	Professional		$57.52	$80.40	$113.71
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $73.22 / $98.65 / $110.85	Professional	25	$73.22	$98.65	$110.85
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $61.00 / $227.44 / $323.52	Facility		$61.00	$227.44	$323.52
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $144.13 / $391.39 / $427.23	Facility	25	$144.13	$391.39	$427.23
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.20 / $97.01 / $212.62	Professional		$82.20	$97.01	$212.62
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $79.17 / $93.87 / $183.98	Professional	25	$79.17	$93.87	$183.98
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $88.08 / $88.08 / $265.00	Facility		$88.08	$88.08	$265.00
MVP Health Care Facility/Professional Facility Modifier 62 Low / Median / High Price $55.05 / $55.05 / $55.05	Facility	62	$55.05	$55.05	$55.05
MVP Health Care Facility/Professional Facility Modifier AS Low / Median / High Price $8.81 / $8.81 / $8.81	Facility	AS	$8.81	$8.81	$8.81
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $100.52 / $193.75	Professional		$55.00	$100.52	$193.75
Optum Facility/Professional Professional Modifier Low / Median / High Price $43.24 / $90.82 / $112.68	Professional		$43.24	$90.82	$112.68
United Facility/Professional Professional Modifier Low / Median / High Price $54.00 / $87.76 / $168.85	Professional		$54.00	$87.76	$168.85
Univera Facility/Professional Facility Modifier Low / Median / High Price $25.09 / $55.40 / $108.13	Facility		$25.09	$55.40	$108.13
Univera Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $102.29 / $168.87	Professional		$70.06	$102.29	$168.87