Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $109.65 / $199.53	Professional		$54.95	$109.65	$199.53
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $28.18 / $134.90 / $251.19	Professional	25	$28.18	$134.90	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $131.83 / $144.54	Professional		$125.89	$131.83	$144.54
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	25	$131.83	$131.83	$131.83
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $144.54 / $234.42	Professional		$109.65	$144.54	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $107.15 / $239.88	Professional		$57.54	$107.15	$239.88
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $70.79 / $194.98	Professional		$39.81	$70.79	$194.98
Horizon BCBS Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $263.03 / $295.12	Facility		$251.19	$263.03	$295.12
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $158.49 / $346.74	Professional		$91.20	$158.49	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $69.18 / $147.91	Professional		$45.71	$69.18	$147.91