Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $263.89 / $2,902.00 / $8,134.00	Facility		$263.89	$2,902.00	$8,134.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $159.38 / $221.32 / $329.32	Facility	54	$159.38	$221.32	$329.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.78 / $248.42 / $483.37	Professional		$200.78	$248.42	$483.37
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,689.00 / $3,373.00 / $4,707.00	Facility		$1,689.00	$3,373.00	$4,707.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $175.41 / $229.30 / $552.77	Professional		$175.41	$229.30	$552.77
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $331.51 / $1,254.00 / $4,050.00	Facility		$331.51	$1,254.00	$4,050.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $331.51 / $331.51 / $335.33	Professional		$331.51	$331.51	$335.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $409.29 / $409.29 / $409.29	Facility		$409.29	$409.29	$409.29
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $286.50 / $286.50 / $286.50	Facility	54	$286.50	$286.50	$286.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $231.25 / $337.57 / $878.68	Professional		$231.25	$337.57	$878.68
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $80.00 / $291.69 / $656.30	Facility		$80.00	$291.69	$656.30
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $270.06 / $383.99 / $566.71	Professional		$270.06	$383.99	$566.71
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $231.91 / $231.91 / $231.91	Facility		$231.91	$231.91	$231.91
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $183.21 / $183.21 / $183.21	Facility	54	$183.21	$183.21	$183.21
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $179.48 / $252.04 / $523.08	Professional		$179.48	$252.04	$523.08
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $409.29 / $555.00 / $597.00	Facility		$409.29	$555.00	$597.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $286.50 / $286.50 / $286.50	Facility	54	$286.50	$286.50	$286.50
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $231.94 / $338.60 / $840.25	Professional		$231.94	$338.60	$840.25
United Facility/Professional Facility Modifier Low / Median / High Price $964.00 / $2,826.00 / $4,851.00	Facility		$964.00	$2,826.00	$4,851.00
United Facility/Professional Professional Modifier Low / Median / High Price $205.76 / $296.51 / $711.76	Professional		$205.76	$296.51	$711.76
Univera Facility/Professional Facility Modifier Low / Median / High Price $294.16 / $294.16 / $857.27	Facility		$294.16	$294.16	$857.27
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $183.21 / $232.38 / $232.38	Facility	54	$183.21	$232.38	$232.38
Univera Facility/Professional Professional Modifier Low / Median / High Price $179.48 / $323.19 / $621.79	Professional		$179.48	$323.19	$621.79