Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $236.74 / $2,807.62 / $9,254.95	Facility		$236.74	$2,807.62	$9,254.95
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $60.86 / $118.37 / $4,292.56	Facility	52	$60.86	$118.37	$4,292.56
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $47.35 / $108.75 / $250.84	Facility	53	$47.35	$108.75	$250.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.79 / $274.87 / $666.11	Professional		$144.79	$274.87	$666.11
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $38.14 / $80.14 / $196.33	Professional	53	$38.14	$80.14	$196.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.94 / $194.75 / $311.92	Professional		$169.94	$194.75	$311.92
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $86.88 / $90.53 / $248.03	Professional	53	$86.88	$90.53	$248.03
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,651.00 / $3,189.00 / $4,636.00	Facility		$1,651.00	$3,189.00	$4,636.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $259.06 / $329.02 / $751.00	Professional		$259.06	$329.02	$751.00
Anthem BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $80.78 / $193.12 / $428.75	Professional	53	$80.78	$193.12	$428.75
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $130.44 / $1,003.00 / $6,213.00	Facility		$130.44	$1,003.00	$6,213.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $130.44 / $245.99 / $491.98	Professional		$130.44	$245.99	$491.98
Cigna Facility/Professional Facility Modifier Low / Median / High Price $243.68 / $243.68 / $4,612.43	Facility		$243.68	$243.68	$4,612.43
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $301.75 / $498.82	Professional		$301.75	$301.75	$498.82
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $133.21 / $197.16 / $361.48	Professional	53	$133.21	$197.16	$361.48
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $204.98 / $281.85 / $489.95	Facility		$204.98	$281.85	$489.95
Emblem Health Facility/Professional Facility Modifier 53 Low / Median / High Price $104.69 / $235.55 / $332.00	Facility	53	$104.69	$235.55	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $382.54 / $475.17 / $962.02	Professional		$382.54	$475.17	$962.02
Emblem Health Facility/Professional Professional Modifier 53 Low / Median / High Price $189.38 / $233.19 / $340.21	Professional	53	$189.38	$233.19	$340.21
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $313.56 / $313.56 / $639.45	Facility		$313.56	$313.56	$639.45
Excellus BCBS Facility/Professional Facility Modifier 53 Low / Median / High Price $156.78 / $156.78 / $156.78	Facility	53	$156.78	$156.78	$156.78
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $308.41 / $814.25 / $1,007.96	Professional		$308.41	$814.25	$1,007.96
Excellus BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $127.71 / $591.62 / $695.87	Professional	53	$127.71	$591.62	$695.87
Fidelis Facility/Professional Professional Modifier Low / Median / High Price $204.98 / $219.65 / $408.95	Professional		$204.98	$219.65	$408.95
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $930.05 / $1,766.94 / $3,664.32	Facility		$930.05	$1,766.94	$3,664.32
Highmark BCBS Facility/Professional Facility Modifier 53 Low / Median / High Price $1,651.00 / $1,651.00 / $1,651.00	Facility	53	$1,651.00	$1,651.00	$1,651.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.16 / $188.04 / $441.82	Professional		$185.16	$188.04	$441.82
Highmark BCBS Facility/Professional Professional Modifier 53 Low / Median / High Price $93.51 / $94.54 / $220.91	Professional	53	$93.51	$94.54	$220.91
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $243.68 / $597.00 / $5,855.00	Facility		$243.68	$597.00	$5,855.00
MVP Health Care Facility/Professional Facility Modifier 52 Low / Median / High Price $194.94 / $194.94 / $194.94	Facility	52	$194.94	$194.94	$194.94
MVP Health Care Facility/Professional Facility Modifier 53 Low / Median / High Price $48.74 / $48.74 / $48.74	Facility	53	$48.74	$48.74	$48.74
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $301.75 / $386.64 / $821.94	Professional		$301.75	$386.64	$821.94
MVP Health Care Facility/Professional Professional Modifier 53 Low / Median / High Price $175.27 / $238.99 / $478.20	Professional	53	$175.27	$238.99	$478.20
United Facility/Professional Facility Modifier Low / Median / High Price $951.00 / $3,235.00 / $5,828.00	Facility		$951.00	$3,235.00	$5,828.00
United Facility/Professional Professional Modifier Low / Median / High Price $276.85 / $385.59 / $902.75	Professional		$276.85	$385.59	$902.75
United Facility/Professional Professional Modifier 53 Low / Median / High Price $52.50 / $52.50 / $204.84	Professional	53	$52.50	$52.50	$204.84
Univera Facility/Professional Facility Modifier Low / Median / High Price $196.26 / $196.26 / $313.56	Facility		$196.26	$196.26	$313.56
Univera Facility/Professional Facility Modifier 53 Low / Median / High Price $98.44 / $98.44 / $98.44	Facility	53	$98.44	$98.44	$98.44
Univera Facility/Professional Professional Modifier Low / Median / High Price $196.26 / $533.16 / $979.81	Professional		$196.26	$533.16	$979.81
Univera Facility/Professional Professional Modifier 53 Low / Median / High Price $98.44 / $350.99 / $664.84	Professional	53	$98.44	$350.99	$664.84