Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $769.50 / $2,106.69 / $6,813.00	Facility		$769.50	$2,106.69	$6,813.00
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $122.80 / $271.08 / $1,002.00	Facility	52	$122.80	$271.08	$1,002.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $49.12 / $67.37 / $155.38	Facility	53	$49.12	$67.37	$155.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $205.10 / $414.38 / $704.93	Professional		$205.10	$414.38	$704.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $103.67 / $199.77 / $276.20	Professional	52	$103.67	$199.77	$276.20
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.47 / $80.11 / $110.48	Professional	53	$41.47	$80.11	$110.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.19 / $205.29 / $328.46	Professional		$151.19	$205.29	$328.46
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $63.76 / $63.76 / $63.76	Professional	52	$63.76	$63.76	$63.76
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $1,206.97 / $2,885.75 / $7,402.45	Facility		$1,206.97	$2,885.75	$7,402.45
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $160.28 / $290.16 / $1,107.40	Professional		$160.28	$290.16	$1,107.40
AmeriHealth Facility/Professional Professional Modifier 52 Low / Median / High Price $508.20 / $508.20 / $508.20	Professional	52	$508.20	$508.20	$508.20
AmeriHealth Facility/Professional Professional Modifier 53 Low / Median / High Price $42.48 / $42.48 / $42.74	Professional	53	$42.48	$42.48	$42.74
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 $234.76 / $455.15 / $992.05	Professional		$234.76	$455.15	$992.05
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $240.00 / $438.75 / $739.32	Professional		$240.00	$438.75	$739.32
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,389.71 / $2,866.57 / $5,087.68	Facility		$2,389.71	$2,866.57	$5,087.68
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $183.21 / $423.94 / $748.13	Professional		$183.21	$423.94	$748.13
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 $324.39 / $440.52 / $1,028.76	Professional		$324.39	$440.52	$1,028.76