Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $760.66 / $2,660.00 / $9,038.00	Facility		$760.66	$2,660.00	$9,038.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $466.82 / $595.41 / $817.49	Facility	54	$466.82	$595.41	$817.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $517.96 / $718.38 / $1,486.12	Professional		$517.96	$718.38	$1,486.12
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $388.47 / $563.78 / $1,027.10	Professional	54	$388.47	$563.78	$1,027.10
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $77.69 / $112.76 / $205.42	Professional	55	$77.69	$112.76	$205.42
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,385.00 / $4,133.00 / $9,074.00	Facility		$2,385.00	$4,133.00	$9,074.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $563.71 / $714.77 / $1,562.51	Professional		$563.71	$714.77	$1,562.51
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $845.56 / $1,072.16 / $2,364.48	Professional	50	$845.56	$1,072.16	$2,364.48
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $841.48 / $1,254.00 / $4,050.00	Facility		$841.48	$1,254.00	$4,050.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $841.48 / $841.48 / $975.64	Professional		$841.48	$841.48	$975.64
Cigna Facility/Professional Facility Modifier Low / Median / High Price $688.55 / $688.55 / $994.17	Facility		$688.55	$688.55	$994.17
Cigna Facility/Professional Facility Modifier 54 Low / Median / High Price $695.92 / $695.92 / $695.92	Facility	54	$695.92	$695.92	$695.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $507.41 / $828.87 / $1,870.61	Professional		$507.41	$828.87	$1,870.61
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $332.00 / $560.00 / $1,526.78	Facility		$332.00	$560.00	$1,526.78
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $762.71 / $929.64 / $1,452.58	Professional		$762.71	$929.64	$1,452.58
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $348.98 / $641.13 / $1,273.76	Professional		$348.98	$641.13	$1,273.76
Excellus BCBS Facility/Professional Professional Modifier 54 Low / Median / High Price $419.00 / $666.78 / $1,168.46	Professional	54	$419.00	$666.78	$1,168.46
Excellus BCBS Facility/Professional Professional Modifier 55 Low / Median / High Price $112.99 / $166.69 / $292.11	Professional	55	$112.99	$166.69	$292.11
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $555.00 / $688.55 / $74,999.25	Facility		$555.00	$688.55	$74,999.25
MVP Health Care Facility/Professional Facility Modifier 54 Low / Median / High Price $695.92 / $695.92 / $695.92	Facility	54	$695.92	$695.92	$695.92
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $538.51 / $838.45 / $1,907.22	Professional		$538.51	$838.45	$1,907.22
United Facility/Professional Facility Modifier Low / Median / High Price $1,500.00 / $3,908.00 / $8,133.00	Facility		$1,500.00	$3,908.00	$8,133.00
United Facility/Professional Professional Modifier Low / Median / High Price $538.65 / $769.87 / $1,703.33	Professional		$538.65	$769.87	$1,703.33
Univera Facility/Professional Facility Modifier Low / Median / High Price $817.38 / $817.38 / $1,603.82	Facility		$817.38	$817.38	$1,603.82
Univera Facility/Professional Facility Modifier 54 Low / Median / High Price $653.91 / $653.91 / $653.91	Facility	54	$653.91	$653.91	$653.91
Univera Facility/Professional Professional Modifier Low / Median / High Price $348.98 / $817.38 / $1,583.62	Professional		$348.98	$817.38	$1,583.62
Univera Facility/Professional Professional Modifier 54 Low / Median / High Price $450.42 / $653.91 / $1,215.85	Professional	54	$450.42	$653.91	$1,215.85
Univera Facility/Professional Professional Modifier 55 Low / Median / High Price $112.60 / $163.47 / $303.97	Professional	55	$112.60	$163.47	$303.97