Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $323.05 / $2,660.00 / $7,307.00	Facility		$323.05	$2,660.00	$7,307.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $213.43 / $280.07 / $395.80	Facility	54	$213.43	$280.07	$395.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.00 / $323.05 / $711.00	Professional		$259.00	$323.05	$711.00
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 $252.98 / $320.77 / $718.97	Professional		$252.98	$320.77	$718.97
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $404.10 / $404.10 / $4,050.00	Facility		$404.10	$404.10	$4,050.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $404.10 / $404.10 / $435.61	Professional		$404.10	$404.10	$435.61
Cigna Facility/Professional Facility Modifier Low / Median / High Price $495.31 / $495.31 / $14,648.00	Facility		$495.31	$495.31	$14,648.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $346.72 / $346.72 / $346.72	Facility	54	$346.72	$346.72	$346.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $293.83 / $437.25 / $1,090.56	Professional		$293.83	$437.25	$1,090.56
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $332.00 / $790.27	Facility		$250.00	$332.00	$790.27
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $348.46 / $494.17 / $728.83	Professional		$348.46	$494.17	$728.83
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $299.23 / $299.23 / $299.23	Facility		$299.23	$299.23	$299.23
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $236.39 / $236.39 / $236.39	Facility	54	$236.39	$236.39	$236.39
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $248.39 / $379.88 / $670.11	Professional		$248.39	$379.88	$670.11
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $361.02 / $414.16 / $429.39	Professional		$361.02	$414.16	$429.39
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $495.31 / $555.00 / $597.00	Facility		$495.31	$555.00	$597.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $346.72 / $346.72 / $346.72	Facility	54	$346.72	$346.72	$346.72
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $297.26 / $446.00 / $1,068.29	Professional		$297.26	$446.00	$1,068.29
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 $270.83 / $379.81 / $953.11	Professional		$270.83	$379.81	$953.11
Univera Facility/Professional Facility Modifier Low / Median / High Price $353.02 / $353.02 / $1,097.70	Facility		$353.02	$353.02	$1,097.70
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $236.39 / $278.89 / $278.89	Facility	54	$236.39	$278.89	$278.89
Univera Facility/Professional Professional Modifier Low / Median / High Price $248.39 / $417.01 / $747.60	Professional		$248.39	$417.01	$747.60