Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $131.83 / $263.03	Facility		$125.89	$131.83	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $316.23	Professional		$125.89	$169.82	$316.23
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $194.98 / $588.84	Professional	25	$138.04	$194.98	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $162.18 / $190.55	Professional		$138.04	$162.18	$190.55
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $154.88 / $181.97	Professional	25	$138.04	$154.88	$181.97
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,011.87 / $8,511.38 / $77,624.71	Facility		$5,011.87	$8,511.38	$77,624.71
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $302.00	Professional		$147.91	$173.78	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $169.82 / $257.04	Professional		$107.15	$169.82	$257.04
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $281.84 / $323.59	Professional		$199.53	$281.84	$323.59
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $131.83 / $251.19	Facility		$125.89	$131.83	$251.19
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $354.81	Professional		$125.89	$169.82	$354.81
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $138.04 / $194.98 / $588.84	Professional	25	$138.04	$194.98	$588.84
Optum Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $204.17	Professional		$141.25	$186.21	$204.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $204.17	Professional		$141.25	$186.21	$204.17
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $151.36 / $177.83	Facility		$112.20	$151.36	$177.83
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $309.03	Professional		$112.20	$151.36	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $309.03	Professional		$141.25	$186.21	$309.03