Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $114.82 / $251.19	Facility		$66.07	$114.82	$251.19
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $141.25 / $229.09 / $257.04	Facility	25	$141.25	$229.09	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $120.23 / $302.00	Professional		$69.18	$120.23	$302.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $125.89 / $295.12	Professional	25	$70.79	$125.89	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $162.18	Professional		$79.43	$112.20	$162.18
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $87.10 / $112.20 / $158.49	Professional	25	$87.10	$112.20	$158.49
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $8,511.38 / $8,511.38 / $77,624.71	Facility		$8,511.38	$8,511.38	$77,624.71
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $120.23 / $173.78	Professional		$102.33	$120.23	$173.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $151.36 / $257.04	Facility		$120.23	$151.36	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $107.15 / $173.78	Professional		$74.13	$107.15	$173.78
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Facility		$158.49	$158.49	$158.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $138.04 / $239.88	Professional		$77.62	$138.04	$239.88
Geisinger Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $104.71	Facility		$87.10	$87.10	$104.71
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $123.03 / $199.53	Professional		$87.10	$123.03	$199.53
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $257.04 / $512.86	Facility		$70.79	$257.04	$512.86
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $70.79 / $93.33 / $257.04	Facility	25	$70.79	$93.33	$257.04
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $177.83	Professional		$85.11	$120.23	$177.83
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $89.13 / $112.20 / $169.82	Professional	25	$89.13	$112.20	$169.82
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $151.36	Professional		$100.00	$125.89	$151.36
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $112.20 / $162.18	Professional		$112.20	$112.20	$162.18
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $107.15 / $245.47	Facility		$66.07	$107.15	$245.47
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $131.83 / $229.09 / $338.84	Facility	25	$131.83	$229.09	$338.84
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $109.65 / $234.42	Professional		$67.61	$109.65	$234.42
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $125.89 / $288.40	Professional	25	$70.79	$125.89	$288.40
Optum Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $114.82 / $141.25	Professional		$50.12	$114.82	$141.25
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $169.82 / $436.52	Facility		$95.50	$169.82	$436.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $177.83 / $245.47	Professional		$95.50	$177.83	$245.47
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $85.11 / $309.03	Facility		$51.29	$85.11	$309.03
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $51.29 / $114.82	Professional		$27.54	$51.29	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $97.72 / $154.88	Professional		$67.61	$97.72	$154.88