Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $650.00 / $1,746.52 / $4,075.03	Facility		$650.00	$1,746.52	$4,075.03
Aetna Facility/Professional Facility Modifier 22 Low / Median / High Price $3,646.92 / $3,646.92 / $3,646.92	Facility	22	$3,646.92	$3,646.92	$3,646.92
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,314.62 / $2,778.87 / $5,000.00	Facility	50	$1,314.62	$2,778.87	$5,000.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.12 / $51.26 / $1,180.76	Facility	53	$22.12	$51.26	$1,180.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.36 / $219.71 / $528.66	Professional		$95.36	$219.71	$528.66
Aetna Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $147.60 / $329.04 / $987.24	Professional	50	$147.60	$329.04	$987.24
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $20.39 / $42.71 / $62.49	Professional	53	$20.39	$42.71	$62.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.80 / $391.30	Professional		$169.82	$257.80	$391.30
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $254.73 / $345.27 / $586.96	Professional	50	$254.73	$345.27	$586.96
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $12,620.65 / $12,620.65 / $12,620.65	Facility		$12,620.65	$12,620.65	$12,620.65
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $114.68 / $201.06 / $772.67	Professional		$114.68	$201.06	$772.67
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $1,772.00 / $2,454.00 / $8,459.92	Facility		$1,772.00	$2,454.00	$8,459.92
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $236.77 / $336.01 / $410.01	Professional		$236.77	$336.01	$410.01
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $355.16 / $504.00 / $615.04	Professional	50	$355.16	$504.00	$615.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $188.07 / $188.07 / $188.07	Facility		$188.07	$188.07	$188.07
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.54 / $217.26 / $431.04	Professional		$109.54	$217.26	$431.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $284.14 / $390.60 / $674.21	Professional		$284.14	$390.60	$674.21
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,139.39 / $2,075.51 / $3,529.68	Facility		$1,139.39	$2,075.51	$3,529.68
Highmark BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $1,264.65 / $3,114.57 / $5,006.51	Facility	50	$1,264.65	$3,114.57	$5,006.51
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.62 / $246.20 / $375.15	Professional		$111.62	$246.20	$375.15
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $167.43 / $213.25 / $562.49	Professional	50	$167.43	$213.25	$562.49
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $12,620.65 / $12,620.65 / $15,989.35	Facility		$12,620.65	$12,620.65	$15,989.35
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $114.68 / $226.97 / $772.67	Professional		$114.68	$226.97	$772.67
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $277.58 / $1,777.00 / $4,125.71	Facility		$277.58	$1,777.00	$4,125.71
Martin's Point Facility/Professional Facility Modifier 22 Low / Median / High Price $3,646.92 / $3,646.92 / $3,646.92	Facility	22	$3,646.92	$3,646.92	$3,646.92
Martin's Point Facility/Professional Facility Modifier 50 Low / Median / High Price $1,337.85 / $2,703.00 / $5,563.06	Facility	50	$1,337.85	$2,703.00	$5,563.06
Martin's Point Facility/Professional Facility Modifier 53 Low / Median / High Price $22.12 / $1,180.76 / $1,180.76	Facility	53	$22.12	$1,180.76	$1,180.76
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $101.93 / $228.25 / $594.00	Professional		$101.93	$228.25	$594.00
Martin's Point Facility/Professional Professional Modifier 22 Low / Median / High Price $141.52 / $141.52 / $191.19	Professional	22	$141.52	$141.52	$191.19
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $150.56 / $324.63 / $968.37	Professional	50	$150.56	$324.63	$968.37
Martin's Point Facility/Professional Professional Modifier 53 Low / Median / High Price $20.39 / $45.65 / $118.09	Professional	53	$20.39	$45.65	$118.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $129.65 / $268.20 / $491.00	Professional		$129.65	$268.20	$491.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $188.07 / $188.07 / $188.07	Facility		$188.07	$188.07	$188.07
Priority Health Facility/Professional Facility Modifier 53 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	53	$37.61	$37.61	$37.61
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $112.07 / $218.39 / $434.45	Professional		$112.07	$218.39	$434.45
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $107.54 / $225.32 / $347.26	Facility		$107.54	$225.32	$347.26
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $107.54 / $233.41 / $255.08	Professional		$107.54	$233.41	$255.08
United Facility/Professional Facility Modifier Low / Median / High Price $435.00 / $1,219.00 / $3,742.00	Facility		$435.00	$1,219.00	$3,742.00
United Facility/Professional Professional Modifier Low / Median / High Price $232.05 / $323.89 / $464.45	Professional		$232.05	$323.89	$464.45