Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $24.50 / $74.88 / $162.22	Facility		$24.50	$74.88	$162.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.58 / $35.29 / $46.35	Professional		$15.58	$35.29	$46.35
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.35 / $46.35 / $46.35	Professional		$46.35	$46.35	$46.35
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $131.16 / $131.16 / $131.16	Facility		$131.16	$131.16	$131.16
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 $32.01 / $36.15 / $36.15	Professional		$32.01	$36.15	$36.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $30.46 / $60.22 / $135.59	Facility		$30.46	$60.22	$135.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $24.37 / $24.37 / $48.38	Professional		$24.37	$24.37	$48.38
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $21.32 / $27.35 / $62.76	Professional		$21.32	$27.35	$62.76
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $24.64 / $130.40 / $216.66	Facility		$24.64	$130.40	$216.66
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $13.50 / $20.66 / $27.81	Professional		$13.50	$20.66	$27.81
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $131.16 / $131.16 / $166.18	Facility		$131.16	$131.16	$166.18
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $26.80 / $86.33 / $191.43	Facility		$26.80	$86.33	$191.43
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $19.38 / $36.15 / $71.33	Professional		$19.38	$36.15	$71.33
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $105.65 / $109.16 / $151.86	Facility		$105.65	$109.16	$151.86
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $30.13 / $60.26 / $154.30	Facility		$30.13	$60.26	$154.30
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $24.37 / $24.37 / $48.38	Professional		$24.37	$24.37	$48.38
United Facility/Professional Facility Modifier Low / Median / High Price $9.77 / $18.54 / $23.18	Facility		$9.77	$18.54	$23.18
United Facility/Professional Professional Modifier Low / Median / High Price $8.16 / $27.81 / $84.82	Professional		$8.16	$27.81	$84.82