Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,417.38 / $3,128.00 / $3,128.00	Facility		$1,417.38	$3,128.00	$3,128.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,944.00 / $3,128.00 / $3,128.00	Professional		$2,944.00	$3,128.00	$3,128.00
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $2,596.23 / $3,054.40 / $8,639.91	Facility		$2,596.23	$3,054.40	$8,639.91
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $3,054.40 / $3,054.40 / $3,054.40	Professional		$3,054.40	$3,054.40	$3,054.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,128.00 / $3,128.00 / $3,128.00	Facility		$3,128.00	$3,128.00	$3,128.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,128.00 / $3,128.00 / $3,128.00	Professional		$3,128.00	$3,128.00	$3,128.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $630.00 / $2,658.80 / $3,128.00	Professional		$630.00	$2,658.80	$3,128.00
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $1,417.38 / $1,417.38 / $3,128.00	Facility		$1,417.38	$1,417.38	$3,128.00
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $1,686.68 / $3,128.00 / $3,128.00	Professional		$1,686.68	$3,128.00	$3,128.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $3,128.00 / $3,128.00 / $3,128.00	Facility		$3,128.00	$3,128.00	$3,128.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $3,128.00 / $3,128.00 / $3,128.00	Professional		$3,128.00	$3,128.00	$3,128.00
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $530.00 / $530.00 / $615.00	Facility		$530.00	$530.00	$615.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $530.00 / $530.00 / $615.00	Professional		$530.00	$530.00	$615.00
United Facility/Professional Professional Modifier Low / Median / High Price $3,200.00 / $3,200.00 / $4,000.00	Professional		$3,200.00	$3,200.00	$4,000.00