Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,213.98 / $9,319.70 / $17,326.84	Facility		$3,213.98	$9,319.70	$17,326.84
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $12,385.35 / $12,385.35 / $18,422.68	Facility	22	$12,385.35	$12,385.35	$18,422.68
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $329.80 / $353.54 / $353.54	Facility	52	$329.80	$353.54	$353.54
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $131.91 / $141.41 / $141.41	Facility	53	$131.91	$141.41	$141.41
Aetna Facility/Professional Facility Modifier AS Low / Median / High Price $87.03 / $87.03 / $87.03	Facility	AS	$87.03	$87.03	$87.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $630.87 / $873.27 / $2,738.00	Professional		$630.87	$873.27	$2,738.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $569.71 / $991.73 / $1,220.82	Professional		$569.71	$991.73	$1,220.82
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $33,889.68 / $33,889.68 / $33,889.68	Facility		$33,889.68	$33,889.68	$33,889.68
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $697.31 / $757.21 / $1,291.75	Professional		$697.31	$757.21	$1,291.75
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $8,639.91 / $10,972.24 / $26,582.19	Facility		$8,639.91	$10,972.24	$26,582.19
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $663.62 / $688.67 / $1,461.20	Professional		$663.62	$688.67	$1,461.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $753.07 / $4,089.81 / $8,136.47	Facility		$753.07	$4,089.81	$8,136.47
Cigna Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Cigna Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $595.00 / $838.55 / $1,402.20	Professional		$595.00	$838.55	$1,402.20
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $1,493.39 / $1,493.39 / $1,493.39	Facility		$1,493.39	$1,493.39	$1,493.39
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $802.10 / $1,032.46 / $1,333.81	Professional		$802.10	$1,032.46	$1,333.81
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,596.42 / $11,772.22 / $21,880.54	Facility		$4,596.42	$11,772.22	$21,880.54
Highmark BCBS Facility/Professional Facility Modifier 22 Low / Median / High Price $16,914.68 / $17,479.56 / $26,151.44	Facility	22	$16,914.68	$17,479.56	$26,151.44
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $641.25 / $687.54 / $897.09	Professional		$641.25	$687.54	$897.09
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $33,889.68 / $33,889.68 / $42,935.51	Facility		$33,889.68	$33,889.68	$42,935.51
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $697.31 / $781.15 / $1,409.37	Professional		$697.31	$781.15	$1,409.37
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $3,180.78 / $9,526.26 / $18,325.68	Facility		$3,180.78	$9,526.26	$18,325.68
Martin's Point Facility/Professional Facility Modifier 22 Low / Median / High Price $4,709.00 / $12,385.35 / $18,422.68	Facility	22	$4,709.00	$12,385.35	$18,422.68
Martin's Point Facility/Professional Facility Modifier 52 Low / Median / High Price $353.54 / $353.54 / $353.54	Facility	52	$353.54	$353.54	$353.54
Martin's Point Facility/Professional Facility Modifier 53 Low / Median / High Price $141.41 / $141.41 / $141.41	Facility	53	$141.41	$141.41	$141.41
Martin's Point Facility/Professional Facility Modifier AS Low / Median / High Price $87.03 / $87.03 / $87.03	Facility	AS	$87.03	$87.03	$87.03
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $632.69 / $957.40 / $2,579.00	Professional		$632.69	$957.40	$2,579.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $795.00 / $795.00 / $795.00	Facility		$795.00	$795.00	$795.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $683.95 / $957.53 / $1,407.00	Professional		$683.95	$957.53	$1,407.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $753.07 / $4,057.72 / $8,136.47	Facility		$753.07	$4,057.72	$8,136.47
Priority Health Facility/Professional Facility Modifier 52 Low / Median / High Price $594.13 / $594.13 / $594.13	Facility	52	$594.13	$594.13	$594.13
Priority Health Facility/Professional Facility Modifier 53 Low / Median / High Price $148.53 / $148.53 / $148.53	Facility	53	$148.53	$148.53	$148.53
Priority Health Facility/Professional Facility Modifier AS Low / Median / High Price $74.27 / $74.27 / $74.27	Facility	AS	$74.27	$74.27	$74.27
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $615.54 / $820.74 / $1,418.52	Professional		$615.54	$820.74	$1,418.52
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $646.17 / $646.17 / $844.50	Facility		$646.17	$646.17	$844.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $620.76 / $655.01 / $844.50	Professional		$620.76	$655.01	$844.50
United Facility/Professional Facility Modifier Low / Median / High Price $1,803.00 / $4,563.00 / $7,156.00	Facility		$1,803.00	$4,563.00	$7,156.00
United Facility/Professional Professional Modifier Low / Median / High Price $597.20 / $781.91 / $1,312.87	Professional		$597.20	$781.91	$1,312.87