Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $931.16 / $5,215.00 / $10,460.00	Facility		$931.16	$5,215.00	$10,460.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $140.90 / $140.90 / $159.38	Facility	53	$140.90	$140.90	$159.38
Aetna Facility/Professional Facility Modifier 54 Low / Median / High Price $528.39 / $528.39 / $597.71	Facility	54	$528.39	$528.39	$597.71
Aetna Facility/Professional Facility Modifier 55 Low / Median / High Price $105.68 / $105.68 / $119.54	Facility	55	$105.68	$105.68	$119.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $539.13 / $664.79 / $1,021.55	Professional		$539.13	$664.79	$1,021.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $269.57 / $329.31 / $510.78	Professional	52	$269.57	$329.31	$510.78
Aetna Facility/Professional Professional Modifier 54 Low / Median / High Price $404.35 / $493.96 / $766.16	Professional	54	$404.35	$493.96	$766.16
Aetna Facility/Professional Professional Modifier 55 Low / Median / High Price $80.87 / $98.79 / $153.22	Professional	55	$80.87	$98.79	$153.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $500.98 / $542.49 / $1,001.96	Professional		$500.98	$542.49	$1,001.96
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $5,253.00 / $8,478.12 / $15,994.00	Facility		$5,253.00	$8,478.12	$15,994.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $583.32 / $829.37 / $2,225.28	Professional		$583.32	$829.37	$2,225.28
AmeriHealth Facility/Professional Professional Modifier 54 Low / Median / High Price $253.73 / $253.73 / $253.73	Professional	54	$253.73	$253.73	$253.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $439.41 / $824.00 / $1,845.98	Professional		$439.41	$824.00	$1,845.98
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $474.03 / $646.00 / $845.81	Professional		$474.03	$646.00	$845.81
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $5,017.54 / $5,340.39 / $12,024.06	Facility		$5,017.54	$5,340.39	$12,024.06
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $448.27 / $664.50 / $1,125.29	Professional		$448.27	$664.50	$1,125.29
United Facility/Professional Facility Modifier Low / Median / High Price $2,595.00 / $5,803.00 / $10,105.00	Facility		$2,595.00	$5,803.00	$10,105.00
United Facility/Professional Professional Modifier Low / Median / High Price $463.59 / $638.07 / $1,167.00	Professional		$463.59	$638.07	$1,167.00