Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $347.68 / $2,626.00 / $8,442.00	Facility		$347.68	$2,626.00	$8,442.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $223.37 / $291.38 / $413.80	Facility	54	$223.37	$291.38	$413.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $266.08 / $327.68 / $778.75	Professional		$266.08	$327.68	$778.75
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 $285.77 / $362.35 / $745.66	Professional		$285.77	$362.35	$745.66
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $421.56 / $1,716.00 / $6,213.00	Facility		$421.56	$1,716.00	$6,213.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $421.56 / $421.56 / $468.35	Professional		$421.56	$421.56	$468.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $514.65 / $514.65 / $514.65	Facility		$514.65	$514.65	$514.65
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $360.25 / $360.25 / $360.25	Facility	54	$360.25	$360.25	$360.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $312.43 / $467.87 / $1,138.51	Professional		$312.43	$467.87	$1,138.51
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $255.00 / $333.93 / $823.10	Facility		$255.00	$333.93	$823.10
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $373.75 / $530.54 / $782.46	Professional		$373.75	$530.54	$782.46
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $320.95 / $320.95 / $320.95	Facility		$320.95	$320.95	$320.95
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $253.55 / $253.55 / $253.55	Facility	54	$253.55	$253.55	$253.55
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $261.77 / $347.99 / $722.19	Professional		$261.77	$347.99	$722.19
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $321.32 / $344.86 / $507.72	Facility		$321.32	$344.86	$507.72
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $355.25 / $387.84 / $864.91	Professional		$355.25	$387.84	$864.91
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $514.65 / $555.00 / $597.00	Facility		$514.65	$555.00	$597.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $360.25 / $360.25 / $360.25	Facility	54	$360.25	$360.25	$360.25
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $313.89 / $471.22 / $1,125.70	Professional		$313.89	$471.22	$1,125.70
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 $288.14 / $414.66 / $982.30	Professional		$288.14	$414.66	$982.30
Univera Facility/Professional Facility Modifier Low / Median / High Price $368.73 / $368.73 / $1,218.54	Facility		$368.73	$368.73	$1,218.54
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $253.55 / $291.30 / $291.30	Facility	54	$253.55	$291.30	$291.30
Univera Facility/Professional Professional Modifier Low / Median / High Price $261.77 / $447.28 / $783.89	Professional		$261.77	$447.28	$783.89