Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $135.74 / $2,399.00 / $7,185.00	Facility		$135.74	$2,399.00	$7,185.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $87.94 / $111.84 / $167.11	Facility	54	$87.94	$111.84	$167.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $106.14 / $125.75 / $312.38	Professional		$106.14	$125.75	$312.38
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $82.16 / $96.77 / $300.74	Professional	54	$82.16	$96.77	$300.74
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 $94.64 / $123.72 / $297.93	Professional		$94.64	$123.72	$297.93
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $168.32 / $168.32 / $6,213.00	Facility		$168.32	$168.32	$6,213.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $168.32 / $168.32 / $171.18	Professional		$168.32	$168.32	$171.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $141.36 / $141.36 / $14,648.00	Facility		$141.36	$141.36	$14,648.00
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $94.65 / $94.65 / $94.65	Facility	54	$94.65	$94.65	$94.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.72 / $178.24 / $427.99	Professional		$119.72	$178.24	$427.99
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $193.92 / $332.00	Facility		$125.00	$193.92	$332.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $136.87 / $191.54 / $281.47	Professional		$136.87	$191.54	$281.47
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $117.53 / $117.53 / $117.53	Facility		$117.53	$117.53	$117.53
Excellus BCBS Facility/Professional Facility Modifier 54 Low / Median / High Price $92.84 / $92.84 / $92.84	Facility	54	$92.84	$92.84	$92.84
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.25 / $127.24 / $264.06	Professional		$97.25	$127.24	$264.06
Excellus BCBS Facility/Professional Professional Modifier 54 Low / Median / High Price $78.95 / $129.97 / $208.61	Professional	54	$78.95	$129.97	$208.61
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.76 / $148.51 / $172.81	Professional		$145.76	$148.51	$172.81
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $141.36 / $555.00 / $597.00	Facility		$141.36	$555.00	$597.00
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $94.65 / $94.65 / $94.65	Facility	54	$94.65	$94.65	$94.65
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $121.62 / $179.91 / $425.75	Professional		$121.62	$179.91	$425.75
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 $106.45 / $149.93 / $357.40	Professional		$106.45	$149.93	$357.40
Univera Facility/Professional Facility Modifier Low / Median / High Price $149.30 / $149.30 / $482.28	Facility		$149.30	$149.30	$482.28
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $92.84 / $117.94 / $117.94	Facility	54	$92.84	$117.94	$117.94
Univera Facility/Professional Professional Modifier Low / Median / High Price $97.25 / $155.68 / $315.58	Professional		$97.25	$155.68	$315.58
Univera Facility/Professional Professional Modifier 54 Low / Median / High Price $92.84 / $129.38 / $249.08	Professional	54	$92.84	$129.38	$249.08