Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.13 / $94.37 / $223.04	Facility		$42.13	$94.37	$223.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.13 / $42.13 / $84.26	Professional		$42.13	$42.13	$84.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $12.64 / $22.75 / $26.33	Professional		$12.64	$22.75	$26.33
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $81.14 / $95.40 / $163.80	Facility		$81.14	$95.40	$163.80
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $13.88 / $42.13 / $56.00	Professional		$13.88	$42.13	$56.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $28.93 / $53.30 / $122.15	Facility		$28.93	$53.30	$122.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.33 / $42.13 / $52.66	Professional		$22.33	$42.13	$52.66
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $42.13 / $42.13 / $42.13	Facility		$42.13	$42.13	$42.13
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $16.85 / $23.17 / $25.28	Professional		$16.85	$23.17	$25.28
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $8,702.00 / $8,702.00 / $8,702.00	Facility		$8,702.00	$8,702.00	$8,702.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.49 / $29.49 / $42.13	Professional		$29.49	$29.49	$42.13
United Facility/Professional Professional Modifier Low / Median / High Price $16.30 / $25.28 / $43.18	Professional		$16.30	$25.28	$43.18