Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.35 / $66.14 / $345.25	Facility		$19.35	$66.14	$345.25
Aetna Facility/Professional Facility Modifier CO Low / Median / High Price $115.14 / $135.57 / $390.10	Facility	CO	$115.14	$135.57	$390.10
Aetna Facility/Professional Facility Modifier CQ Low / Median / High Price $38.95 / $95.82 / $677.26	Facility	CQ	$38.95	$95.82	$677.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.42 / $25.16 / $206.21	Professional		$16.42	$25.16	$206.21
Aetna Facility/Professional Professional Modifier CO Low / Median / High Price $76.17 / $76.17 / $76.17	Professional	CO	$76.17	$76.17	$76.17
Aetna Facility/Professional Professional Modifier CQ Low / Median / High Price $32.46 / $50.53 / $97.04	Professional	CQ	$32.46	$50.53	$97.04
Ambetter Facility/Professional Professional Modifier CQ Low / Median / High Price $15.67 / $15.67 / $18.73	Professional	CQ	$15.67	$15.67	$18.73
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $13.20 / $17.60 / $22.40	Professional		$13.20	$17.60	$22.40
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $57,255.43 / $79,506.39	Facility		$5,000.00	$57,255.43	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $25.64 / $30.17 / $48.40	Professional		$25.64	$30.17	$48.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $65.00 / $75.00	Facility		$61.66	$65.00	$75.00
Cigna Facility/Professional Facility Modifier CO Low / Median / High Price $27.88 / $27.88 / $27.88	Facility	CO	$27.88	$27.88	$27.88
Cigna Facility/Professional Facility Modifier CQ Low / Median / High Price $27.88 / $27.88 / $27.88	Facility	CQ	$27.88	$27.88	$27.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.41 / $57.00 / $111.17	Professional		$22.41	$57.00	$111.17
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $45.00 / $94.00	Professional		$45.00	$45.00	$94.00
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $36.81 / $70.09 / $85.57	Facility		$36.81	$70.09	$85.57
Highmark BCBS Facility/Professional Facility Modifier CO Low / Median / High Price $34.94 / $50.62 / $140.61	Facility	CO	$34.94	$50.62	$140.61
Highmark BCBS Facility/Professional Facility Modifier CQ Low / Median / High Price $40.22 / $54.94 / $101.36	Facility	CQ	$40.22	$54.94	$101.36
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $20.79 / $25.18 / $28.60	Professional		$20.79	$25.18	$28.60
Highmark BCBS Facility/Professional Professional Modifier CQ Low / Median / High Price $36.34 / $36.34 / $36.34	Professional	CQ	$36.34	$36.34	$36.34
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $29.93 / $29.93 / $29.93	Facility		$29.93	$29.93	$29.93
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $13.20 / $13.20 / $22.40	Professional		$13.20	$13.20	$22.40
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $23.20 / $99.01 / $539.30	Facility		$23.20	$99.01	$539.30
Martin's Point Facility/Professional Facility Modifier CO Low / Median / High Price $90.71 / $135.57 / $390.10	Facility	CO	$90.71	$135.57	$390.10
Martin's Point Facility/Professional Facility Modifier CQ Low / Median / High Price $63.66 / $190.00 / $766.75	Facility	CQ	$63.66	$190.00	$766.75
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $16.79 / $27.57 / $123.00	Professional		$16.79	$27.57	$123.00
Martin's Point Facility/Professional Professional Modifier CO Low / Median / High Price $76.17 / $76.17 / $76.17	Professional	CO	$76.17	$76.17	$76.17
Martin's Point Facility/Professional Professional Modifier CQ Low / Median / High Price $28.33 / $55.69 / $88.42	Professional	CQ	$28.33	$55.69	$88.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.81 / $41.32 / $59.92	Professional		$20.81	$41.32	$59.92
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $65.00 / $75.00	Facility		$61.66	$65.00	$75.00
Priority Health Facility/Professional Facility Modifier CO Low / Median / High Price $27.88 / $27.88 / $27.88	Facility	CO	$27.88	$27.88	$27.88
Priority Health Facility/Professional Facility Modifier CQ Low / Median / High Price $27.88 / $27.88 / $27.88	Facility	CQ	$27.88	$27.88	$27.88
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $24.17 / $60.82 / $112.19	Professional		$24.17	$60.82	$112.19
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $27.26 / $28.84 / $28.84	Facility		$27.26	$28.84	$28.84
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $27.26 / $28.84 / $30.38	Professional		$27.26	$28.84	$30.38
United Facility/Professional Professional Modifier Low / Median / High Price $25.20 / $30.46 / $45.69	Professional		$25.20	$30.46	$45.69