Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $528.66 / $2,729.00 / $6,438.00	Facility		$528.66	$2,729.00	$6,438.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $101.90 / $522.63 / $2,729.00	Facility	52	$101.90	$522.63	$2,729.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $46.97 / $118.28 / $239.16	Facility	53	$46.97	$118.28	$239.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.75 / $329.62 / $578.32	Professional		$184.75	$329.62	$578.32
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $40.76 / $86.48 / $206.80	Professional	53	$40.76	$86.48	$206.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $172.22 / $213.27 / $322.27	Professional		$172.22	$213.27	$322.27
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $62.73 / $78.47 / $91.38	Professional	53	$62.73	$78.47	$91.38
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $1,077.13 / $2,421.00 / $3,696.00	Facility		$1,077.13	$2,421.00	$3,696.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $195.67 / $348.20 / $1,234.40	Professional		$195.67	$348.20	$1,234.40
AmeriHealth Facility/Professional Professional Modifier 53 Low / Median / High Price $118.58 / $118.58 / $237.16	Professional	53	$118.58	$118.58	$237.16
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,438.00 / $3,438.00 / $3,438.00	Facility		$3,438.00	$3,438.00	$3,438.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $200.56 / $381.62 / $814.25	Professional		$200.56	$381.62	$814.25
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $68.08 / $143.90 / $336.15	Professional	53	$68.08	$143.90	$336.15
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $146.25 / $390.00 / $627.10	Professional		$146.25	$390.00	$627.10
Emblem Health Facility/Professional Professional Modifier 53 Low / Median / High Price $175.27 / $255.66 / $313.92	Professional	53	$175.27	$255.66	$313.92
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,788.75 / $2,216.56 / $4,501.68	Facility		$1,788.75	$2,216.56	$4,501.68
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.20 / $326.33 / $603.62	Professional		$169.20	$326.33	$603.62
United Facility/Professional Facility Modifier Low / Median / High Price $3,204.00 / $5,225.00 / $10,536.00	Facility		$3,204.00	$5,225.00	$10,536.00
United Facility/Professional Professional Modifier Low / Median / High Price $248.60 / $359.32 / $795.87	Professional		$248.60	$359.32	$795.87