Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.99 / $83.73 / $540.58	Facility		$56.99	$83.73	$540.58
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $315.60 / $538.04 / $1,198.32	Facility	25	$315.60	$538.04	$1,198.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $134.05 / $260.14	Professional		$82.59	$134.05	$260.14
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $103.99 / $203.22 / $491.00	Professional	25	$103.99	$203.22	$491.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.34 / $204.88 / $318.07	Professional		$144.34	$204.88	$318.07
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $169.85 / $195.12 / $312.19	Professional	25	$169.85	$195.12	$312.19
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $532.84 / $532.84 / $532.84	Facility		$532.84	$532.84	$532.84
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $148.05 / $227.66 / $382.50	Professional		$148.05	$227.66	$382.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $119.90 / $159.00 / $218.28	Facility		$119.90	$159.00	$218.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.84 / $175.57 / $295.70	Professional		$108.84	$175.57	$295.70
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $57.71 / $183.03 / $298.66	Professional		$57.71	$183.03	$298.66
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.19 / $170.99 / $260.25	Professional		$118.19	$170.99	$260.25
United Facility/Professional Professional Modifier Low / Median / High Price $74.09 / $161.32 / $278.85	Professional		$74.09	$161.32	$278.85