Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.87 / $1,175.43 / $3,340.00	Facility		$115.87	$1,175.43	$3,340.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $1,119.96 / $2,967.75 / $4,478.35	Facility	50	$1,119.96	$2,967.75	$4,478.35
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $10.21 / $10.21 / $23.17	Facility	53	$10.21	$10.21	$23.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.50 / $96.96 / $285.04	Professional		$47.50	$96.96	$285.04
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $69.93 / $122.49 / $261.13	Professional	50	$69.93	$122.49	$261.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.53 / $115.72 / $175.65	Professional		$77.53	$115.72	$175.65
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $6,111.51 / $6,111.51 / $6,111.51	Facility		$6,111.51	$6,111.51	$6,111.51
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $2,299.82 / $2,746.00 / $13,822.74	Facility		$2,299.82	$2,746.00	$13,822.74
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $106.75 / $151.81 / $176.55	Professional		$106.75	$151.81	$176.55
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $160.13 / $227.73 / $271.97	Professional	50	$160.13	$227.73	$271.97
Cigna Facility/Professional Facility Modifier Low / Median / High Price $86.31 / $86.31 / $86.31	Facility		$86.31	$86.31	$86.31
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $17.26 / $17.26 / $17.26	Facility	53	$17.26	$17.26	$17.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.23 / $98.65 / $195.49	Professional		$55.23	$98.65	$195.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $118.59 / $168.97 / $220.06	Professional		$118.59	$168.97	$220.06
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $391.63 / $810.94 / $1,125.28	Facility		$391.63	$810.94	$1,125.28
Highmark BCBS Facility/Professional Facility Modifier 50 Low / Median / High Price $687.88 / $687.88 / $840.28	Facility	50	$687.88	$687.88	$840.28
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.33 / $65.86 / $175.71	Professional		$48.33	$65.86	$175.71
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $76.40 / $76.40 / $76.40	Professional	50	$76.40	$76.40	$76.40
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $6,111.51 / $6,111.51 / $7,742.80	Facility		$6,111.51	$6,111.51	$7,742.80
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $75.00 / $927.64 / $3,873.00	Facility		$75.00	$927.64	$3,873.00
Martin's Point Facility/Professional Facility Modifier 50 Low / Median / High Price $1,119.96 / $2,967.75 / $4,478.35	Facility	50	$1,119.96	$2,967.75	$4,478.35
Martin's Point Facility/Professional Facility Modifier 53 Low / Median / High Price $10.21 / $10.21 / $23.17	Facility	53	$10.21	$10.21	$23.17
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $48.59 / $103.64 / $295.17	Professional		$48.59	$103.64	$295.17
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $69.93 / $122.49 / $329.02	Professional	50	$69.93	$122.49	$329.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $168.81 / $262.60	Professional		$63.52	$168.81	$262.60
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $86.31 / $86.31 / $86.31	Facility		$86.31	$86.31	$86.31
Priority Health Facility/Professional Facility Modifier 53 Low / Median / High Price $17.26 / $17.26 / $17.26	Facility	53	$17.26	$17.26	$17.26
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $55.14 / $100.70 / $196.93	Professional		$55.14	$100.70	$196.93
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $50.24 / $107.78 / $192.22	Facility		$50.24	$107.78	$192.22
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $50.24 / $106.02 / $115.68	Professional		$50.24	$106.02	$115.68
United Facility/Professional Facility Modifier Low / Median / High Price $162.00 / $577.00 / $3,742.00	Facility		$162.00	$577.00	$3,742.00
United Facility/Professional Professional Modifier Low / Median / High Price $99.15 / $145.65 / $214.11	Professional		$99.15	$145.65	$214.11