Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.77 / $137.77 / $137.77	Facility		$137.77	$137.77	$137.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.66 / $137.77 / $137.77	Professional		$129.66	$137.77	$137.77
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $137.77 / $162.08 / $243.12	Facility		$137.77	$162.08	$243.12
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $162.08 / $162.08	Professional		$162.08	$162.08	$162.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $162.08 / $162.08 / $162.08	Facility		$162.08	$162.08	$162.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $162.08 / $162.08	Professional		$162.08	$162.08	$162.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $137.77 / $162.08 / $207.03	Professional		$137.77	$162.08	$207.03
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $137.77 / $137.77 / $232.83	Facility		$137.77	$137.77	$232.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $129.66 / $137.77 / $163.95	Professional		$129.66	$137.77	$163.95
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $162.08 / $162.08 / $162.08	Facility		$162.08	$162.08	$162.08
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $162.08 / $162.08 / $168.19	Professional		$162.08	$162.08	$168.19
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $29.92 / $29.92 / $29.92	Facility		$29.92	$29.92	$29.92
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $29.92 / $29.92 / $30.52	Professional		$29.92	$29.92	$30.52
United Facility/Professional Professional Modifier Low / Median / High Price $161.97 / $162.08 / $221.91	Professional		$161.97	$162.08	$221.91