Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,817.57 / $9,348.00 / $50,539.00	Facility		$1,817.57	$9,348.00	$50,539.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $19,434.06 / $31,862.86 / $80,694.25	Facility	50	$19,434.06	$31,862.86	$80,694.25
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,050.81 / $1,245.59 / $1,713.20	Facility	54	$1,050.81	$1,245.59	$1,713.20
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $13,896.56 / $13,896.56 / $13,896.56	Facility	AS	$13,896.56	$13,896.56	$13,896.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,209.38 / $1,701.99 / $15,589.40	Professional		$1,209.38	$1,701.99	$15,589.40
Aetna Facility/Professional Professional Modifier AS Low / Median / High Price $148.71 / $282.00 / $799.27	Professional	AS	$148.71	$282.00	$799.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,162.27 / $1,687.79 / $1,919.23	Professional		$1,162.27	$1,687.79	$1,919.23
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,826.00 / $13,400.00 / $64,715.00	Facility		$4,826.00	$13,400.00	$64,715.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,186.83 / $1,551.42 / $3,635.66	Professional		$1,186.83	$1,551.42	$3,635.66
Anthem BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $166.15 / $217.19 / $506.43	Professional	AS	$166.15	$217.19	$506.43
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $1,814.05 / $16,814.00 / $21,218.00	Facility		$1,814.05	$16,814.00	$21,218.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $1,814.05 / $1,814.05 / $1,814.05	Professional		$1,814.05	$1,814.05	$1,814.05
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,455.37 / $41,574.00 / $50,089.00	Facility		$1,455.37	$41,574.00	$50,089.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $1,008.15	Facility	54	$1,008.15	$1,008.15	$1,008.15
Cigna Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $900.13	Facility	62	$900.13	$900.13	$900.13
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $144.02	Facility	AS	$144.02	$144.02	$144.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,293.01 / $2,184.21 / $5,866.86	Professional		$1,293.01	$2,184.21	$5,866.86
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $332.00 / $2,022.00 / $52,948.00	Facility		$332.00	$2,022.00	$52,948.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $1,396.64 / $2,122.85 / $5,481.00	Professional		$1,396.64	$2,122.85	$5,481.00
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,199.34 / $1,199.34 / $1,199.34	Facility		$1,199.34	$1,199.34	$1,199.34
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $947.49 / $947.49 / $947.49	Facility	54	$947.49	$947.49	$947.49
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,152.57 / $1,530.60 / $2,700.02	Professional		$1,152.57	$1,530.60	$2,700.02
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,050.79 / $17,410.16 / $24,991.51	Facility		$4,050.79	$17,410.16	$24,991.51
Highmark BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $9,025.74 / $9,025.74 / $9,025.74	Facility	50	$9,025.74	$9,025.74	$9,025.74
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,343.97 / $1,821.61 / $4,000.00	Professional		$1,343.97	$1,821.61	$4,000.00
Highmark BCBS Facility/Professional Professional Modifier AS Low / Median / High Price $189.13 / $375.55 / $510.00	Professional	AS	$189.13	$375.55	$510.00
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $555.00 / $37,385.00 / $50,089.00	Facility		$555.00	$37,385.00	$50,089.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $1,008.15 / $1,008.15 / $1,008.15	Facility	54	$1,008.15	$1,008.15	$1,008.15
MVP Health Care Facility/Professional Facility Modifier 62 Low / Median / High Price $900.13 / $900.13 / $900.13	Facility	62	$900.13	$900.13	$900.13
MVP Health Care Facility/Professional Facility Modifier AS Low / Median / High Price $144.02 / $144.02 / $144.02	Facility	AS	$144.02	$144.02	$144.02
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $1,373.65 / $2,104.87 / $5,064.70	Professional		$1,373.65	$2,104.87	$5,064.70
United Facility/Professional Facility Modifier Low / Median / High Price $2,673.00 / $11,420.00 / $44,373.00	Facility		$2,673.00	$11,420.00	$44,373.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,207.49 / $1,691.05 / $4,444.70	Professional		$1,207.49	$1,691.05	$4,444.70
Univera Facility/Professional Facility Modifier Low / Median / High Price $1,530.60 / $1,530.60 / $6,465.89	Facility		$1,530.60	$1,530.60	$6,465.89
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $947.49 / $1,209.17 / $1,209.17	Facility	54	$947.49	$1,209.17	$1,209.17
Univera Facility/Professional Professional Modifier Low / Median / High Price $1,226.08 / $1,671.42 / $3,235.44	Professional		$1,226.08	$1,671.42	$3,235.44