Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.00 / $149.38 / $323.85	Facility		$111.00	$149.38	$323.85
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $103.95 / $228.24 / $385.06	Facility	25	$103.95	$228.24	$385.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $159.43 / $379.35	Professional		$93.00	$159.43	$379.35
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $109.44 / $196.82 / $441.45	Professional	25	$109.44	$196.82	$441.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.33 / $237.19 / $302.23	Professional		$148.33	$237.19	$302.23
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $144.34 / $183.17 / $302.23	Professional	25	$144.34	$183.17	$302.23
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $148.58 / $148.58 / $148.58	Facility		$148.58	$148.58	$148.58
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $147.86 / $186.13 / $286.35	Professional		$147.86	$186.13	$286.35
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 $189.75 / $196.53 / $277.17	Professional		$189.75	$196.53	$277.17
Cigna Facility/Professional Facility Modifier Low / Median / High Price $125.00 / $175.00 / $194.00	Facility		$125.00	$175.00	$194.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.09 / $168.82 / $264.02	Professional		$111.09	$168.82	$264.02
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $313.22 / $313.22 / $313.22	Facility		$313.22	$313.22	$313.22
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $60.38 / $229.27 / $360.87	Professional		$60.38	$229.27	$360.87
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $157.19 / $157.19 / $240.83	Facility		$157.19	$157.19	$240.83
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $104.80 / $207.00 / $328.96	Facility	25	$104.80	$207.00	$328.96
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.02 / $187.22 / $273.33	Professional		$128.02	$187.22	$273.33
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $142.47 / $186.65 / $282.93	Professional	25	$142.47	$186.65	$282.93
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $148.58 / $148.58 / $148.58	Facility		$148.58	$148.58	$148.58
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $147.86 / $186.13 / $286.35	Professional		$147.86	$186.13	$286.35
Johns Hopkins Employer Health Plan Facility/Professional Facility Modifier Low / Median / High Price $160.94 / $160.94 / $160.94	Facility		$160.94	$160.94	$160.94
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $160.94 / $160.94 / $213.68	Professional		$160.94	$160.94	$213.68
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $88.01 / $149.04 / $308.85	Facility		$88.01	$149.04	$308.85
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $98.64 / $286.38 / $747.29	Facility	25	$98.64	$286.38	$747.29
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $107.23 / $166.07 / $343.72	Professional		$107.23	$166.07	$343.72
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $109.44 / $195.76 / $407.86	Professional	25	$109.44	$195.76	$407.86
Optum Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $179.94 / $218.02	Professional		$100.00	$179.94	$218.02
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $123.30 / $123.30 / $123.30	Facility		$123.30	$123.30	$123.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.30 / $203.30 / $338.84	Professional		$123.30	$203.30	$338.84
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $119.90 / $160.00 / $191.64	Facility		$119.90	$160.00	$191.64
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $111.09 / $169.42 / $261.61	Professional		$111.09	$169.42	$261.61
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $111.52 / $174.06 / $174.06	Facility		$111.52	$174.06	$174.06
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $136.19 / $148.57 / $183.25	Professional		$136.19	$148.57	$183.25
United Facility/Professional Professional Modifier Low / Median / High Price $117.57 / $158.30 / $272.17	Professional		$117.57	$158.30	$272.17