Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $980.82 / $5,330.34 / $10,871.00	Facility		$980.82	$5,330.34	$10,871.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $4,990.00 / $4,990.00 / $4,990.00	Facility	50	$4,990.00	$4,990.00	$4,990.00
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $735.62 / $735.62 / $741.07	Facility	54	$735.62	$735.62	$741.07
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $147.12 / $147.12 / $148.21	Facility	55	$147.12	$147.12	$148.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $739.26 / $912.60 / $1,267.11	Professional		$739.26	$912.60	$1,267.11
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $554.45 / $684.45 / $950.34	Professional	54	$554.45	$684.45	$950.34
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $110.89 / $136.88 / $190.07	Professional	55	$110.89	$136.88	$190.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $798.05 / $798.05 / $837.95	Professional		$798.05	$798.05	$837.95
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $806.86 / $1,521.00 / $2,060.44	Professional		$806.86	$1,521.00	$2,060.44
AmeriHealth Facility/Professional Professional Modifier 54 Low / Median / High Price $564.79 / $564.79 / $564.79	Professional	54	$564.79	$564.79	$564.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $601.19 / $1,010.90 / $2,291.38	Professional		$601.19	$1,010.90	$2,291.38
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $528.00 / $872.39 / $1,157.17	Professional		$528.00	$872.39	$1,157.17
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,474.74 / $5,081.78 / $5,544.92	Facility		$4,474.74	$5,081.78	$5,544.92
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $614.29 / $865.13 / $1,492.73	Professional		$614.29	$865.13	$1,492.73
United Facility/Professional Facility Modifier Low / Median / High Price $3,885.00 / $7,250.00 / $10,536.00	Facility		$3,885.00	$7,250.00	$10,536.00
United Facility/Professional Professional Modifier Low / Median / High Price $612.08 / $852.52 / $1,614.57	Professional		$612.08	$852.52	$1,614.57