Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $75.86 / $177.83	Facility		$69.18	$75.86	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $93.33 / $186.21	Professional		$67.61	$93.33	$186.21
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $162.18 / $173.78 / $316.23	Professional	25	$162.18	$173.78	$316.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $117.49	Professional		$77.62	$95.50	$117.49
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $93.33 / $114.82	Professional	25	$81.28	$93.33	$114.82
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 $95.50 / $112.20 / $165.96	Professional		$95.50	$112.20	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $100.00 / $138.04	Professional		$75.86	$100.00	$138.04
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $165.96 / $190.55	Professional		$117.49	$165.96	$190.55
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $77.62 / $102.33	Facility		$69.18	$77.62	$102.33
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $194.98	Professional		$69.18	$95.50	$194.98
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $162.18 / $173.78 / $316.23	Professional	25	$162.18	$173.78	$316.23
Optum Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $87.10 / $112.20	Professional		$54.95	$87.10	$112.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $87.10 / $112.20	Professional		$54.95	$87.10	$112.20
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $21.38 / $83.18 / $104.71	Facility		$21.38	$83.18	$104.71
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $87.10 / $309.03	Professional		$21.38	$87.10	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $104.71 / $173.78	Professional		$79.43	$104.71	$173.78