Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $117.49 / $457.09	Facility		$56.23	$117.49	$457.09
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $95.50 / $281.84 / $831.76	Facility	25	$95.50	$281.84	$831.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $123.03 / $302.00	Professional		$57.54	$123.03	$302.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $61.66 / $131.83 / $338.84	Professional	25	$61.66	$131.83	$338.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $95.50 / $95.50 / $234.42	Professional	50	$95.50	$95.50	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $117.49 / $154.88	Professional		$81.28	$117.49	$154.88
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $95.50 / $123.03 / $162.18	Professional	25	$95.50	$123.03	$162.18
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 / $72.44 / $147.91	Professional		$0.79	$72.44	$147.91
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $141.25 / $141.25	Facility		$128.82	$141.25	$141.25
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $141.25 / $181.97	Professional		$141.25	$141.25	$181.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $151.36 / $245.47	Facility		$97.72	$151.36	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $134.90 / $269.15	Professional		$77.62	$134.90	$269.15
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $34.67 / $154.88	Facility		$34.67	$34.67	$154.88
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $53.70 / $223.87	Professional		$50.12	$53.70	$223.87
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $38.02 / $144.54	Facility		$36.31	$38.02	$144.54
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $131.83 / $257.04	Professional		$91.20	$131.83	$257.04
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $117.49 / $173.78	Professional		$70.79	$117.49	$173.78
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $74.13 / $114.82 / $165.96	Professional	25	$74.13	$114.82	$165.96
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $12.30 / $218.78 / $467.74	Facility		$12.30	$218.78	$467.74
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $50.12 / $213.80 / $562.34	Facility	25	$50.12	$213.80	$562.34
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $134.90 / $213.80	Professional		$120.23	$134.90	$213.80
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $117.49 / $131.83 / $169.82	Professional	25	$117.49	$131.83	$169.82
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $151.36 / $281.84	Professional		$117.49	$151.36	$281.84
Optum Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $125.89 / $165.96	Professional		$56.23	$125.89	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Facility		$69.18	$69.18	$69.18
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $100.00 / $186.21	Professional		$58.88	$100.00	$186.21
Univera Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $66.07 / $144.54	Facility		$36.31	$66.07	$144.54
Univera Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $138.04 / $239.88	Professional		$97.72	$138.04	$239.88