Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $78.31 / $85.90 / $147.97	Facility		$78.31	$85.90	$147.97
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $892.06 / $892.06 / $892.06	Facility	25	$892.06	$892.06	$892.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.13 / $122.43 / $337.30	Professional		$80.13	$122.43	$337.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $111.81 / $153.85 / $195.23	Professional		$111.81	$153.85	$195.23
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $106.01 / $113.58 / $205.68	Professional		$106.01	$113.58	$205.68
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $8,639.91 / $79,506.39	Facility		$5,000.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $117.87 / $168.38 / $200.78	Professional		$117.87	$168.38	$200.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $135.36 / $135.36 / $135.36	Facility		$135.36	$135.36	$135.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.35 / $125.73 / $188.73	Professional		$91.35	$125.73	$188.73
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $134.38 / $225.00	Professional		$52.00	$134.38	$225.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.87 / $123.36 / $187.93	Professional		$108.87	$123.36	$187.93
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $106.01 / $118.32 / $205.68	Professional		$106.01	$118.32	$205.68
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $78.31 / $82.40 / $147.97	Facility		$78.31	$82.40	$147.97
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $892.06 / $892.06 / $892.06	Facility	25	$892.06	$892.06	$892.06
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $80.13 / $121.38 / $258.39	Professional		$80.13	$121.38	$258.39
Optum Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $119.28 / $128.50	Professional		$72.00	$119.28	$128.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $88.60 / $165.51 / $222.40	Professional		$88.60	$165.51	$222.40
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $135.36 / $135.36 / $135.36	Facility		$135.36	$135.36	$135.36
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $91.35 / $125.73 / $189.17	Professional		$91.35	$125.73	$189.17
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $107.07 / $116.58 / $116.58	Facility		$107.07	$116.58	$116.58
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $76.68 / $116.58 / $121.17	Professional		$76.68	$116.58	$121.17
United Facility/Professional Professional Modifier Low / Median / High Price $86.01 / $116.82 / $192.53	Professional		$86.01	$116.82	$192.53