Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $365.37 / $2,220.00 / $7,185.00	Facility		$365.37	$2,220.00	$7,185.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $210.85 / $302.77 / $451.08	Facility	54	$210.85	$302.77	$451.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.92 / $356.77 / $842.56	Professional		$252.92	$356.77	$842.56
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,108.61 / $1,108.61 / $1,108.61	Professional	50	$1,108.61	$1,108.61	$1,108.61
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $210.85 / $268.10 / $792.63	Professional	54	$210.85	$268.10	$792.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $317.92 / $317.92 / $317.92	Professional		$317.92	$317.92	$317.92
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 $279.80 / $354.78 / $783.45	Professional		$279.80	$354.78	$783.45
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $419.70 / $532.17 / $1,168.03	Professional	50	$419.70	$532.17	$1,168.03
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $456.46 / $456.46 / $6,213.00	Facility		$456.46	$456.46	$6,213.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $456.46 / $456.46 / $478.91	Professional		$456.46	$456.46	$478.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $560.70 / $560.70 / $14,648.00	Facility		$560.70	$560.70	$14,648.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $392.49 / $392.49 / $392.49	Facility	54	$392.49	$392.49	$392.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $317.83 / $461.37 / $1,178.38	Professional		$317.83	$461.37	$1,178.38
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $372.90 / $902.81	Facility		$250.00	$372.90	$902.81
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $385.92 / $527.10 / $886.86	Professional		$385.92	$527.10	$886.86
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $331.40 / $331.40 / $331.40	Facility		$331.40	$331.40	$331.40
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $261.81 / $261.81 / $261.81	Facility	54	$261.81	$261.81	$261.81
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $236.93 / $421.17 / $742.95	Professional		$236.93	$421.17	$742.95
Excellus BCBS Facility/Professional Professional Modifier 54 Low / Median / High Price $207.15 / $372.27 / $586.92	Professional	54	$207.15	$372.27	$586.92
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $402.12 / $475.48 / $475.68	Facility		$402.12	$475.48	$475.68
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $341.81 / $448.02 / $833.96	Professional		$341.81	$448.02	$833.96
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $1,327.31 / $1,327.31 / $1,327.31	Professional	50	$1,327.31	$1,327.31	$1,327.31
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $555.00 / $560.70 / $597.00	Facility		$555.00	$560.70	$597.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $392.49 / $392.49 / $392.49	Facility	54	$392.49	$392.49	$392.49
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $320.85 / $470.60 / $1,136.49	Professional		$320.85	$470.60	$1,136.49
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 $293.69 / $414.44 / $1,060.28	Professional		$293.69	$414.44	$1,060.28
Univera Facility/Professional Facility Modifier Low / Median / High Price $403.00 / $403.00 / $1,052.50	Facility		$403.00	$403.00	$1,052.50
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $261.81 / $318.37 / $318.37	Facility	54	$261.81	$318.37	$318.37
Univera Facility/Professional Professional Modifier Low / Median / High Price $243.43 / $461.84 / $851.89	Professional		$243.43	$461.84	$851.89
Univera Facility/Professional Professional Modifier 54 Low / Median / High Price $261.81 / $372.27 / $672.99	Professional	54	$261.81	$372.27	$672.99