Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.35 / $160.53 / $389.28	Facility		$106.35	$160.53	$389.28
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $209.79 / $451.68 / $762.50	Facility	25	$209.79	$451.68	$762.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.04 / $155.06 / $412.20	Professional		$82.04	$155.06	$412.20
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $95.64 / $218.03 / $522.00	Professional	25	$95.64	$218.03	$522.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $133.65 / $170.89 / $263.07	Professional		$133.65	$170.89	$263.07
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $143.91 / $181.00 / $230.89	Professional	25	$143.91	$181.00	$230.89
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 / $106.20 / $252.83	Professional		$0.80	$106.20	$252.83
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $128.00 / $206.61 / $574.00	Facility		$128.00	$206.61	$574.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $206.61 / $206.61 / $254.83	Professional		$206.61	$206.61	$254.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $110.00 / $191.64 / $249.00	Facility		$110.00	$191.64	$249.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.79 / $192.83 / $378.82	Professional		$109.79	$192.83	$378.82
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $175.28 / $332.00	Facility		$35.00	$175.28	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $53.43 / $126.78 / $320.98	Professional		$53.43	$126.78	$320.98
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $48.24 / $71.81 / $169.83	Facility		$48.24	$71.81	$169.83
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $129.91 / $190.21 / $335.68	Professional		$129.91	$190.21	$335.68
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $157.44 / $218.42 / $223.71	Professional		$157.44	$218.42	$223.71
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $100.80 / $151.16 / $199.43	Professional	25	$100.80	$151.16	$199.43
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $54.82 / $777.09 / $777.09	Facility		$54.82	$777.09	$777.09
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $50.00 / $50.00 / $50.00	Facility	25	$50.00	$50.00	$50.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.19 / $187.88 / $304.00	Professional		$162.19	$187.88	$304.00
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $161.38 / $183.37 / $279.77	Professional	25	$161.38	$183.37	$279.77
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $127.00 / $191.64 / $265.00	Facility		$127.00	$191.64	$265.00
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $111.16 / $202.58 / $380.53	Professional		$111.16	$202.58	$380.53
Optum Facility/Professional Professional Modifier Low / Median / High Price $82.25 / $178.23 / $224.29	Professional		$82.25	$178.23	$224.29
United Facility/Professional Professional Modifier Low / Median / High Price $94.25 / $169.71 / $329.29	Professional		$94.25	$169.71	$329.29
Univera Facility/Professional Facility Modifier Low / Median / High Price $48.24 / $71.81 / $234.00	Facility		$48.24	$71.81	$234.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $150.97 / $203.33 / $366.45	Professional		$150.97	$203.33	$366.45