Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $86.17 / $169.64 / $1,523.20	Facility		$86.17	$169.64	$1,523.20
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $636.36 / $761.60 / $3,884.33	Facility	25	$636.36	$761.60	$3,884.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.17 / $106.40 / $393.00	Professional		$86.17	$106.40	$393.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $101.25 / $229.30 / $559.61	Professional	25	$101.25	$229.30	$559.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.05 / $163.83 / $196.27	Professional		$107.05	$163.83	$196.27
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $106.73 / $155.22 / $201.30	Professional	25	$106.73	$155.22	$201.30
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $113.91 / $118.51 / $221.43	Professional		$113.91	$118.51	$221.43
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $119.09 / $164.89 / $232.68	Professional		$119.09	$164.89	$232.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $143.15 / $143.15 / $3,687.16	Facility		$143.15	$143.15	$3,687.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.47 / $134.65 / $229.23	Professional		$100.47	$134.65	$229.23
Emblem Health Facility/Professional Facility Modifier Low / Median / High Price $232.07 / $232.07 / $232.07	Facility		$232.07	$232.07	$232.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $136.91 / $180.87 / $321.93	Professional		$136.91	$180.87	$321.93
Highmark BCBS Facility/Professional Facility Modifier 25 Low / Median / High Price $105.20 / $105.20 / $105.20	Facility	25	$105.20	$105.20	$105.20
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.97 / $161.22 / $911.30	Professional		$122.97	$161.22	$911.30
Highmark BCBS Facility/Professional Professional Modifier 25 Low / Median / High Price $115.58 / $135.27 / $193.55	Professional	25	$115.58	$135.27	$193.55
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $113.91 / $118.51 / $226.93	Professional		$113.91	$118.51	$226.93
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $96.05 / $176.89 / $1,523.20	Facility		$96.05	$176.89	$1,523.20
Martin's Point Facility/Professional Facility Modifier 25 Low / Median / High Price $489.38 / $761.60 / $3,884.33	Facility	25	$489.38	$761.60	$3,884.33
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $90.95 / $143.06 / $397.20	Professional		$90.95	$143.06	$397.20
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $105.38 / $232.44 / $541.99	Professional	25	$105.38	$232.44	$541.99
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $115.00 / $8,161.03 / $8,161.03	Facility		$115.00	$8,161.03	$8,161.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $115.00 / $155.62 / $255.10	Professional		$115.00	$155.62	$255.10
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $143.15 / $143.15 / $3,687.16	Facility		$143.15	$143.15	$3,687.16
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $100.65 / $134.65 / $224.98	Professional		$100.65	$134.65	$224.98
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $105.13 / $113.78 / $122.29	Professional		$105.13	$113.78	$122.29
United Facility/Professional Professional Modifier Low / Median / High Price $103.12 / $132.22 / $220.51	Professional		$103.12	$132.22	$220.51
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $85.00 / $144.66	Professional	25	$80.00	$85.00	$144.66