Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.08 / $266.98 / $457.20	Facility		$118.08	$266.98	$457.20
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $111.00 / $111.00 / $431.79	Facility	25	$111.00	$111.00	$431.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.83 / $218.29 / $536.00	Professional		$138.83	$218.29	$536.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $147.32 / $268.14 / $682.00	Professional	25	$147.32	$268.14	$682.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.06 / $302.00 / $406.07	Professional		$190.06	$302.00	$406.07
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $195.46 / $225.27 / $371.70	Professional	25	$195.46	$225.27	$371.70
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $187.26 / $187.26 / $187.26	Facility		$187.26	$187.26	$187.26
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $215.11 / $248.63 / $406.83	Professional		$215.11	$248.63	$406.83
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 $198.25 / $241.56 / $241.56	Professional		$198.25	$241.56	$241.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $175.00 / $242.44	Facility		$125.00	$175.00	$242.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.63 / $222.38 / $350.88	Professional		$161.63	$222.38	$350.88
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $397.45 / $397.45 / $397.45	Facility		$397.45	$397.45	$397.45
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $101.45 / $280.99 / $445.78	Professional		$101.45	$280.99	$445.78
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $210.00 / $340.33 / $488.76	Facility		$210.00	$340.33	$488.76
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $127.20 / $127.20 / $476.83	Facility	25	$127.20	$127.20	$476.83
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.36 / $234.13 / $355.93	Professional		$181.36	$234.13	$355.93
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $181.36 / $220.10 / $321.69	Professional	25	$181.36	$220.10	$321.69
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $187.26 / $187.26 / $223.40	Facility		$187.26	$187.26	$223.40
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $197.24 / $248.63 / $406.83	Professional		$197.24	$248.63	$406.83
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $245.83 / $245.83 / $245.83	Facility		$245.83	$245.83	$245.83
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $245.83 / $245.83 / $304.72	Professional		$245.83	$245.83	$304.72
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $142.19 / $226.08 / $429.34	Facility		$142.19	$226.08	$429.34
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $111.00 / $188.10 / $458.72	Facility	25	$111.00	$188.10	$458.72
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $148.66 / $231.76 / $473.99	Professional		$148.66	$231.76	$473.99
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $155.03 / $274.39 / $644.17	Professional	25	$155.03	$274.39	$644.17
Optum Facility/Professional Professional Modifier Low / Median / High Price $124.00 / $231.66 / $262.47	Professional		$124.00	$231.66	$262.47
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $175.80 / $175.80 / $175.80	Facility		$175.80	$175.80	$175.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $175.80 / $254.27 / $436.70	Professional		$175.80	$254.27	$436.70
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $173.16 / $242.44	Facility		$125.00	$173.16	$242.44
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $164.31 / $224.00 / $354.08	Professional		$164.31	$224.00	$354.08
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $166.57 / $213.80 / $213.80	Facility		$166.57	$213.80	$213.80
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $171.79 / $189.00 / $224.96	Professional		$171.79	$189.00	$224.96
United Facility/Professional Professional Modifier Low / Median / High Price $167.81 / $223.40 / $384.39	Professional		$167.81	$223.40	$384.39
United Facility/Professional Professional Modifier 25 Low / Median / High Price $75.00 / $80.00 / $88.00	Professional	25	$75.00	$80.00	$88.00