Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $173.78 / $354.81	Facility		$107.15	$173.78	$354.81
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $151.36 / $331.13 / $426.58	Facility	25	$151.36	$331.13	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $436.52	Professional		$107.15	$181.97	$436.52
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $114.82 / $199.53 / $489.78	Professional	25	$114.82	$199.53	$489.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $239.88	Professional		$123.03	$169.82	$239.88
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $131.83 / $169.82 / $229.09	Professional	25	$131.83	$169.82	$229.09
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 $48.98 / $223.87 / $302.00	Professional		$48.98	$223.87	$302.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $165.96 / $257.04	Facility		$120.23	$165.96	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $165.96 / $275.42	Professional		$120.23	$165.96	$275.42
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Facility		$263.03	$263.03	$263.03
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $204.17 / $363.08	Professional		$77.62	$204.17	$363.08
Geisinger Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $134.90 / $158.49	Facility		$134.90	$134.90	$158.49
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $186.21 / $302.00	Professional		$134.90	$186.21	$302.00
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $323.59 / $416.87	Facility		$102.33	$323.59	$416.87
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $295.12 / $323.59 / $331.13	Facility	25	$295.12	$323.59	$331.13
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $177.83 / $239.88	Professional		$138.04	$177.83	$239.88
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $141.25 / $169.82 / $223.87	Professional	25	$141.25	$169.82	$223.87
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $213.80	Professional		$147.91	$186.21	$213.80
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Facility		$190.55	$190.55	$190.55
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $245.47	Professional		$190.55	$190.55	$245.47
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $165.96 / $354.81	Facility		$107.15	$165.96	$354.81
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $117.49 / $323.59 / $426.58	Facility	25	$117.49	$323.59	$426.58
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $165.96 / $354.81	Professional		$107.15	$165.96	$354.81
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $114.82 / $199.53 / $457.09	Professional	25	$114.82	$199.53	$457.09
Optum Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $173.78 / $208.93	Professional		$89.13	$173.78	$208.93
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $229.09 / $363.08	Facility		$107.15	$229.09	$363.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $263.03 / $354.81	Professional		$107.15	$263.03	$354.81
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $128.82 / $186.21	Facility		$66.07	$128.82	$186.21
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $100.00 / $186.21	Professional		$33.11	$100.00	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $154.88 / $245.47	Professional		$109.65	$154.88	$245.47