Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $171.58 / $520.39 / $1,907.00	Facility		$171.58	$520.39	$1,907.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $498.41 / $1,719.35 / $2,618.25	Facility	25	$498.41	$1,719.35	$2,618.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.76 / $239.91 / $785.52	Professional		$170.76	$239.91	$785.52
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $189.83 / $311.39 / $957.42	Professional	25	$189.83	$311.39	$957.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $201.30 / $267.38 / $630.48	Professional		$201.30	$267.38	$630.48
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $194.46 / $262.94 / $773.57	Professional	25	$194.46	$262.94	$773.57
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,196.00 / $2,256.00 / $2,439.00	Facility		$2,196.00	$2,256.00	$2,439.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $214.20 / $266.00 / $585.64	Professional		$214.20	$266.00	$585.64
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $308.19 / $308.19 / $1,486.00	Facility		$308.19	$308.19	$1,486.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $308.19 / $308.19 / $393.18	Professional		$308.19	$308.19	$393.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $286.33 / $286.33 / $2,428.00	Facility		$286.33	$286.33	$2,428.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.12 / $345.51 / $778.44	Professional		$202.12	$345.51	$778.44
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $130.00 / $319.00 / $498.41	Facility		$130.00	$319.00	$498.41
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $287.30 / $402.14 / $745.05	Professional		$287.30	$402.14	$745.05
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $256.36 / $256.36 / $256.36	Facility		$256.36	$256.36	$256.36
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.56 / $352.49 / $570.47	Professional		$223.56	$352.49	$570.47
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $143.69 / $253.79 / $261.07	Professional		$143.69	$253.79	$261.07
Fidelis Facility/Professional Professional Modifier 25 Low / Median / High Price $253.79 / $255.37 / $255.37	Professional	25	$253.79	$255.37	$255.37
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,891.58 / $1,900.36 / $2,292.84	Facility		$1,891.58	$1,900.36	$2,292.84
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $1,096.82 / $1,884.99 / $2,276.79	Facility	25	$1,096.82	$1,884.99	$2,276.79
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $294.16 / $346.07 / $600.80	Professional		$294.16	$346.07	$600.80
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $250.00 / $460.12 / $645.16	Professional	25	$250.00	$460.12	$645.16
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $286.33 / $286.33 / $2,428.00	Facility		$286.33	$286.33	$2,428.00
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $203.07 / $365.54 / $761.74	Professional		$203.07	$365.54	$761.74
United Facility/Professional Facility Modifier Low / Median / High Price $1,804.87 / $1,804.87 / $2,362.40	Facility		$1,804.87	$1,804.87	$2,362.40
United Facility/Professional Professional Modifier Low / Median / High Price $203.76 / $313.97 / $647.70	Professional		$203.76	$313.97	$647.70
Univera Facility/Professional Facility Modifier Low / Median / High Price $256.36 / $256.36 / $256.36	Facility		$256.36	$256.36	$256.36
Univera Facility/Professional Professional Modifier Low / Median / High Price $263.01 / $419.39 / $551.76	Professional		$263.01	$419.39	$551.76