Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Facility		$1,224.00	$1,224.00	$1,224.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,152.00 / $1,224.00 / $1,224.00	Professional		$1,152.00	$1,224.00	$1,224.00
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $1,015.92 / $1,195.20 / $8,639.91	Facility		$1,015.92	$1,195.20	$8,639.91
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $1,195.20 / $1,195.20 / $1,195.20	Professional		$1,195.20	$1,195.20	$1,195.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Facility		$1,224.00	$1,224.00	$1,224.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Professional		$1,224.00	$1,224.00	$1,224.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $459.42 / $1,040.40 / $1,224.00	Professional		$459.42	$1,040.40	$1,224.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Facility		$1,224.00	$1,224.00	$1,224.00
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $1,152.00 / $1,224.00 / $1,224.00	Professional		$1,152.00	$1,224.00	$1,224.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Facility		$1,224.00	$1,224.00	$1,224.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $1,224.00 / $1,224.00 / $1,224.00	Professional		$1,224.00	$1,224.00	$1,224.00
United Facility/Professional Professional Modifier Low / Median / High Price $1,200.00 / $1,200.00 / $1,657.20	Professional		$1,200.00	$1,200.00	$1,657.20