Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $213.80 / $263.03	Facility		$87.10	$213.80	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $102.33	Professional		$87.10	$87.10	$102.33
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $95.50 / $5,011.87	Facility		$81.28	$95.50	$5,011.87
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $91.20	Professional		$91.20	$91.20	$91.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Geisinger Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $151.36 / $151.36	Professional		$131.83	$151.36	$151.36
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $213.80 / $263.03	Facility		$87.10	$213.80	$263.03
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $239.88	Professional		$87.10	$87.10	$239.88
United Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $120.23	Professional		$87.10	$87.10	$120.23