Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $110.71 / $909.00 / $2,130.46	Facility		$110.71	$909.00	$2,130.46
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $553.50 / $1,107.00 / $3,544.97	Facility	25	$553.50	$1,107.00	$3,544.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.35 / $116.80 / $262.13	Professional		$84.35	$116.80	$262.13
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $97.24 / $180.94 / $384.00	Professional	25	$97.24	$180.94	$384.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $116.43 / $186.21 / $438.00	Professional		$116.43	$186.21	$438.00
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $121.26 / $186.21 / $459.41	Professional	25	$121.26	$186.21	$459.41
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $118.73 / $158.57 / $261.24	Professional		$118.73	$158.57	$261.24
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $2,191.75 / $2,479.00 / $3,535.00	Facility		$2,191.75	$2,479.00	$3,535.00
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $121.26 / $167.42 / $214.37	Professional		$121.26	$167.42	$214.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $139.63 / $2,559.00 / $3,255.00	Facility		$139.63	$2,559.00	$3,255.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.47 / $144.19 / $258.77	Professional		$107.47	$144.19	$258.77
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $262.50 / $262.50 / $262.50	Facility		$262.50	$262.50	$262.50
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $137.50 / $210.27 / $346.49	Professional		$137.50	$210.27	$346.49
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,048.59 / $1,087.23 / $2,041.78	Facility		$1,048.59	$1,087.23	$2,041.78
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $1,073.84 / $1,152.08 / $1,450.13	Facility	25	$1,073.84	$1,152.08	$1,450.13
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.18 / $157.80 / $234.43	Professional		$141.18	$157.80	$234.43
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $130.07 / $156.16 / $265.95	Professional	25	$130.07	$156.16	$265.95
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $776.00 / $776.00 / $776.00	Facility		$776.00	$776.00	$776.00
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $126.82 / $167.29 / $255.93	Professional		$126.82	$167.29	$255.93
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $110.71 / $850.14 / $1,994.00	Facility		$110.71	$850.14	$1,994.00
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $553.50 / $1,107.00 / $3,544.97	Facility	25	$553.50	$1,107.00	$3,544.97
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $93.03 / $131.55 / $260.81	Professional		$93.03	$131.55	$260.81
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $96.94 / $171.88 / $291.58	Professional	25	$96.94	$171.88	$291.58
Optum Facility/Professional Professional Modifier Low / Median / High Price $121.32 / $127.39 / $165.00	Professional		$121.32	$127.39	$165.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,207.80 / $1,207.80 / $1,207.80	Facility		$1,207.80	$1,207.80	$1,207.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $116.60 / $172.21 / $245.52	Professional		$116.60	$172.21	$245.52
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $139.63 / $1,250.00 / $3,100.00	Facility		$139.63	$1,250.00	$3,100.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $108.08 / $145.16 / $258.77	Professional		$108.08	$145.16	$258.77
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $115.15 / $120.19 / $123.06	Professional		$115.15	$120.19	$123.06
United Facility/Professional Professional Modifier Low / Median / High Price $98.75 / $131.47 / $225.53	Professional		$98.75	$131.47	$225.53