Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $117.49 / $165.96	Facility		$54.95	$117.49	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $54.95 / $141.25	Professional		$53.70	$54.95	$141.25
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $58.88 / $5,011.87	Facility		$50.12	$58.88	$5,011.87
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Professional		$56.23	$56.23	$56.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Facility		$54.95	$54.95	$54.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Professional		$54.95	$54.95	$54.95
Geisinger Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Facility		$54.95	$54.95	$54.95
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $95.50 / $95.50	Professional		$81.28	$95.50	$95.50
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $117.49 / $165.96	Facility		$54.95	$117.49	$165.96
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $54.95 / $151.36	Professional		$53.70	$54.95	$151.36
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $63.10 / $309.03	Facility		$54.95	$63.10	$309.03
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $54.95 / $309.03	Professional		$30.90	$54.95	$309.03
United Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Facility		$54.95	$54.95	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $54.95 / $75.86	Professional		$54.95	$54.95	$75.86