Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $686.50 / $812.96 / $1,504.83	Facility		$686.50	$812.96	$1,504.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $686.50 / $1,088.30 / $1,210.60	Professional		$686.50	$1,088.30	$1,210.60
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,868.10 / $1,905.46 / $3,736.20	Facility		$1,868.10	$1,905.46	$3,736.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,131.33 / $1,131.33 / $3,015.02	Professional		$1,131.33	$1,131.33	$3,015.02
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $1,447.45 / $1,556.40 / $1,556.40	Facility		$1,447.45	$1,556.40	$1,556.40
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $1,556.40 / $1,556.40 / $1,556.40	Professional		$1,556.40	$1,556.40	$1,556.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,167.30 / $1,167.30 / $1,167.30	Facility		$1,167.30	$1,167.30	$1,167.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $852.13 / $852.13 / $1,167.30	Professional		$852.13	$852.13	$1,167.30
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $319.00 / $1,868.10 / $4,203.22	Facility		$319.00	$1,868.10	$4,203.22
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $964.63 / $1,401.08 / $3,362.58	Professional		$964.63	$1,401.08	$3,362.58
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $732.25 / $732.25 / $732.25	Facility		$732.25	$732.25	$732.25
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $732.25 / $1,123.10 / $1,339.61	Professional		$732.25	$1,123.10	$1,339.61
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $597.00 / $1,167.30 / $1,868.10	Facility		$597.00	$1,167.30	$1,868.10
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $852.13 / $1,112.97 / $2,827.70	Professional		$852.13	$1,112.97	$2,827.70
United Facility/Professional Professional Modifier Low / Median / High Price $621.32 / $1,120.85 / $1,681.29	Professional		$621.32	$1,120.85	$1,681.29
Univera Facility/Professional Facility Modifier Low / Median / High Price $1,123.10 / $1,123.10 / $1,167.13	Facility		$1,123.10	$1,123.10	$1,167.13
Univera Facility/Professional Professional Modifier Low / Median / High Price $732.25 / $1,123.10 / $1,193.30	Professional		$732.25	$1,123.10	$1,193.30