Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $106.33 / $204.06 / $4,817.26	Facility		$106.33	$204.06	$4,817.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $107.40 / $994.75	Professional		$106.33	$107.40	$994.75
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.04 / $163.60 / $163.60	Professional		$136.04	$163.60	$163.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $85.06 / $85.06 / $106.33	Facility		$85.06	$85.06	$106.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $106.33 / $369.68	Professional		$106.33	$106.33	$369.68
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $202.10 / $202.10 / $212.21	Facility		$202.10	$202.10	$212.21
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $202.10 / $202.10 / $202.10	Professional		$202.10	$202.10	$202.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.32 / $169.92 / $354.88	Facility		$100.32	$169.92	$354.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $106.33 / $115.36	Professional		$106.33	$106.33	$115.36
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $116.47 / $165.53 / $332.00	Facility		$116.47	$165.53	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $99.00 / $116.47 / $148.88	Professional		$99.00	$116.47	$148.88
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $106.33 / $106.33 / $109.38	Facility		$106.33	$106.33	$109.38
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $109.38 / $109.38	Professional		$106.33	$109.38	$109.38
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $100.32 / $266.60 / $354.88	Facility		$100.32	$266.60	$354.88
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $106.33 / $166.05	Professional		$106.33	$106.33	$166.05
United Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $112.71 / $163.15	Professional		$106.33	$112.71	$163.15
Univera Facility/Professional Facility Modifier Low / Median / High Price $109.38 / $109.38 / $109.38	Facility		$109.38	$109.38	$109.38
Univera Facility/Professional Professional Modifier Low / Median / High Price $106.33 / $109.38 / $109.38	Professional		$106.33	$109.38	$109.38