Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $375.05 / $4,037.00 / $7,757.42	Facility		$375.05	$4,037.00	$7,757.42
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $101.20 / $187.53 / $2,515.94	Facility	52	$101.20	$187.53	$2,515.94
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $40.47 / $75.01 / $128.86	Facility	53	$40.47	$75.01	$128.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.84 / $274.67 / $430.96	Professional		$170.84	$274.67	$430.96
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $37.88 / $75.01 / $168.59	Professional	53	$37.88	$75.01	$168.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.09 / $199.69 / $324.31	Professional		$165.09	$199.69	$324.31
Ambetter Facility/Professional Professional Modifier 53 Low / Median / High Price $150.49 / $150.49 / $150.49	Professional	53	$150.49	$150.49	$150.49
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $2,500.00 / $2,500.00 / $2,500.00	Facility		$2,500.00	$2,500.00	$2,500.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $197.20 / $232.10 / $1,185.80	Professional		$197.20	$232.10	$1,185.80
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 $301.45 / $301.45 / $301.45	Professional		$301.45	$301.45	$301.45
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $41.90 / $131.02 / $245.51	Professional	53	$41.90	$131.02	$245.51
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $349.97 / $485.60 / $672.73	Professional		$349.97	$485.60	$672.73
Emblem Health Facility/Professional Professional Modifier 53 Low / Median / High Price $174.71 / $242.59 / $313.20	Professional	53	$174.71	$242.59	$313.20
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,005.74 / $2,216.56 / $4,227.18	Facility		$2,005.74	$2,216.56	$4,227.18
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $267.17 / $314.32 / $326.05	Professional		$267.17	$314.32	$326.05
United Facility/Professional Facility Modifier Low / Median / High Price $1,882.00 / $3,823.00 / $10,536.00	Facility		$1,882.00	$3,823.00	$10,536.00
United Facility/Professional Professional Modifier Low / Median / High Price $254.70 / $360.93 / $795.17	Professional		$254.70	$360.93	$795.17