Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $213.80 / $213.80	Facility		$107.15	$213.80	$213.80
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $281.84 / $281.84 / $281.84	Facility	25	$281.84	$281.84	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $128.82 / $239.88	Professional		$89.13	$128.82	$239.88
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $104.71 / $144.54 / $218.78	Professional	25	$104.71	$144.54	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $120.23 / $141.25	Professional		$102.33	$120.23	$141.25
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $72.44 / $120.23 / $141.25	Professional	25	$72.44	$120.23	$141.25
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $158.49 / $223.87	Professional		$128.82	$158.49	$223.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $204.17	Facility		$95.50	$95.50	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $194.98 / $309.03	Professional		$158.49	$194.98	$309.03
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $123.03 / $154.88	Professional		$104.71	$123.03	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $204.17	Professional		$93.33	$125.89	$204.17