Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $371.54	Professional		$112.20	$112.20	$371.54
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $812.83 / $5,011.87	Facility		$691.83	$812.83	$5,011.87
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Professional		$812.83	$812.83	$812.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $117.49	Professional		$112.20	$112.20	$117.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $707.95 / $831.76	Professional		$154.88	$707.95	$831.76
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $162.18 / $218.78	Professional		$120.23	$162.18	$218.78
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $173.78	Professional		$112.20	$112.20	$173.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $0.60 / $194.98 / $245.47	Professional		$0.60	$194.98	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $190.55 / $933.25	Professional		$125.89	$190.55	$933.25