Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,649.60 / $3,264.00 / $3,264.00	Facility		$2,649.60	$3,264.00	$3,264.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,649.60 / $3,187.20 / $3,264.00	Professional		$2,649.60	$3,187.20	$3,264.00
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,493.26 / $1,493.26 / $1,866.58	Facility		$1,493.26	$1,493.26	$1,866.58
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,200.00 / $3,200.00 / $3,300.00	Professional		$3,200.00	$3,200.00	$3,300.00
CDPHP Facility/Professional Facility Modifier Low / Median / High Price $3,300.00 / $3,300.00 / $3,300.00	Facility		$3,300.00	$3,300.00	$3,300.00
CDPHP Facility/Professional Professional Modifier Low / Median / High Price $3,300.00 / $3,300.00 / $3,300.00	Professional		$3,300.00	$3,300.00	$3,300.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,264.00 / $3,366.00 / $3,570.99	Facility		$3,264.00	$3,366.00	$3,570.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,264.00 / $3,264.00 / $3,264.00	Professional		$3,264.00	$3,264.00	$3,264.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $3,564.00 / $3,564.00 / $6,165.72	Facility		$3,564.00	$3,564.00	$6,165.72
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $3,029.40 / $3,564.00 / $3,564.00	Professional		$3,029.40	$3,564.00	$3,564.00
Excellus BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,366.00 / $3,498.00 / $3,498.00	Facility		$3,366.00	$3,498.00	$3,498.00
Excellus BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,366.00 / $3,366.00 / $3,498.00	Professional		$3,366.00	$3,366.00	$3,498.00
MVP Health Care Facility/Professional Facility Modifier Low / Median / High Price $597.00 / $3,366.00 / $3,570.99	Facility		$597.00	$3,366.00	$3,570.99
MVP Health Care Facility/Professional Professional Modifier Low / Median / High Price $3,264.00 / $3,264.00 / $3,264.00	Professional		$3,264.00	$3,264.00	$3,264.00
United Facility/Professional Professional Modifier Low / Median / High Price $3,200.00 / $3,200.00 / $4,484.26	Professional		$3,200.00	$3,200.00	$4,484.26
Univera Facility/Professional Facility Modifier Low / Median / High Price $3,366.00 / $3,366.00 / $3,366.00	Facility		$3,366.00	$3,366.00	$3,366.00
Univera Facility/Professional Professional Modifier Low / Median / High Price $3,366.00 / $3,366.00 / $3,498.00	Professional		$3,366.00	$3,366.00	$3,498.00