Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $160.88 / $696.84 / $5,673.09	Facility		$160.88	$696.84	$5,673.09
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $608.51 / $2,201.90 / $7,911.26	Facility	25	$608.51	$2,201.90	$7,911.26
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $156.03 / $255.66 / $548.00	Professional	25	$156.03	$255.66	$548.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $184.06 / $290.02 / $670.86	Professional	25	$184.06	$290.02	$670.86
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $1,647.00 / $1,647.00 / $4,441.00	Facility		$1,647.00	$1,647.00	$4,441.00
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $3,259.69 / $3,559.00 / $4,976.00	Facility		$3,259.69	$3,559.00	$4,976.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $202.43 / $3,100.00 / $4,114.00	Facility		$202.43	$3,100.00	$4,114.00
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $380.63 / $380.63 / $380.63	Facility		$380.63	$380.63	$380.63
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,647.78 / $1,682.50 / $7,345.59	Facility		$1,647.78	$1,682.50	$7,345.59
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $1,546.16 / $1,706.54 / $6,056.77	Facility	25	$1,546.16	$1,706.54	$6,056.77
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $188.61 / $234.80 / $380.75	Professional	25	$188.61	$234.80	$380.75
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $1,647.00 / $1,647.00 / $4,441.00	Facility		$1,647.00	$1,647.00	$4,441.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $160.88 / $696.84 / $5,606.82	Facility		$160.88	$696.84	$5,606.82
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $600.00 / $2,074.00 / $7,644.60	Facility	25	$600.00	$2,074.00	$7,644.60
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $140.56 / $254.47 / $427.28	Professional	25	$140.56	$254.47	$427.28
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $202.43 / $1,250.00 / $3,100.00	Facility		$202.43	$1,250.00	$3,100.00