Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $22.90 / $129.00 / $413.00	Facility		$22.90	$129.00	$413.00
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $80.19 / $129.00 / $250.00	Facility	CQ	$80.19	$129.00	$250.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.00 / $18.69 / $31.05	Professional		$13.00	$18.69	$31.05
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $240.00 / $240.00 / $240.00	Professional	CQ	$240.00	$240.00	$240.00
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $46.96 / $105.04 / $181.30	Facility		$46.96	$105.04	$181.30
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $17.07 / $23.66 / $58.14	Professional		$17.07	$23.66	$58.14
AmeriHealth Facility/Professional Professional Modifier 52 Low / Median / High Price $12.81 / $17.07 / $33.44	Professional	52	$12.81	$17.07	$33.44
AmeriHealth Facility/Professional Professional Modifier CQ Low / Median / High Price $20.11 / $27.57 / $34.00	Professional	CQ	$20.11	$27.57	$34.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $80.00 / $163.65 / $163.65	Facility		$80.00	$163.65	$163.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $68.00 / $113.16	Professional		$28.00	$68.00	$113.16
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $55.00 / $94.00	Professional		$45.00	$55.00	$94.00
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $18.89 / $21.17 / $33.15	Professional		$18.89	$21.17	$33.15
United Facility/Professional Professional Modifier Low / Median / High Price $19.29 / $27.14 / $34.93	Professional		$19.29	$27.14	$34.93