Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $116.61 / $254.25	Facility		$69.18	$116.61	$254.25
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $200.61 / $230.62 / $250.98	Facility	25	$200.61	$230.62	$250.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.84 / $110.24 / $258.48	Professional		$65.84	$110.24	$258.48
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $66.91 / $118.55 / $266.60	Professional	25	$66.91	$118.55	$266.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $91.77 / $140.41 / $199.37	Professional		$91.77	$140.41	$199.37
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $103.56 / $119.76 / $187.98	Professional	25	$103.56	$119.76	$187.98
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $84.64 / $84.64 / $84.64	Facility		$84.64	$84.64	$84.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $100.28 / $125.20 / $206.84	Professional		$100.28	$125.20	$206.84
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $197.00 / $8,639.91 / $79,506.39	Facility		$197.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $103.35 / $121.59 / $212.50	Professional		$103.35	$121.59	$212.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $109.51 / $147.00 / $194.00	Facility		$109.51	$147.00	$194.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.09 / $110.06 / $173.22	Professional		$76.09	$110.06	$173.22
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $179.32 / $179.32 / $179.32	Facility		$179.32	$179.32	$179.32
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $81.17 / $152.19 / $227.76	Professional		$81.17	$152.19	$227.76
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $71.39 / $255.39 / $481.33	Facility		$71.39	$255.39	$481.33
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $246.13 / $246.13 / $246.13	Facility	25	$246.13	$246.13	$246.13
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $121.74 / $178.93	Professional		$87.10	$121.74	$178.93
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $93.77 / $117.67 / $176.90	Professional	25	$93.77	$117.67	$176.90
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $84.64 / $84.64 / $116.05	Facility		$84.64	$84.64	$116.05
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $100.28 / $125.20 / $206.84	Professional		$100.28	$125.20	$206.84
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $112.06 / $112.06 / $112.06	Facility		$112.06	$112.06	$112.06
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.06 / $112.06 / $160.85	Professional		$112.06	$112.06	$160.85
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $65.89 / $111.00 / $242.70	Facility		$65.89	$111.00	$242.70
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $200.61 / $230.62 / $293.70	Facility	25	$200.61	$230.62	$293.70
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $113.49 / $238.57	Professional		$69.18	$113.49	$238.57
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $69.30 / $118.31 / $242.57	Professional	25	$69.30	$118.31	$242.57
Optum Facility/Professional Professional Modifier Low / Median / High Price $58.25 / $118.48 / $144.90	Professional		$58.25	$118.48	$144.90
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $169.21 / $169.21 / $435.30	Facility		$169.21	$169.21	$435.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $92.68 / $126.04 / $227.70	Professional		$92.68	$126.04	$227.70
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $109.51 / $135.00 / $190.00	Facility		$109.51	$135.00	$190.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $76.09 / $111.03 / $175.40	Professional		$76.09	$111.03	$175.40
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $80.94 / $108.76 / $108.76	Facility		$80.94	$108.76	$108.76
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $80.94 / $100.44 / $114.99	Professional		$80.94	$100.44	$114.99
United Facility/Professional Professional Modifier Low / Median / High Price $82.35 / $115.30 / $201.25	Professional		$82.35	$115.30	$201.25