Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.77 / $88.77 / $117.86	Facility	26	$88.77	$88.77	$117.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.42 / $338.46 / $498.59	Professional		$269.42	$338.46	$498.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.68 / $88.71 / $125.69	Professional	26	$74.68	$88.71	$125.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.74 / $231.34 / $310.98	Professional	TC	$194.74	$231.34	$310.98
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $203.19 / $268.70 / $278.85	Professional		$203.19	$268.70	$278.85
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $63.07 / $117.27 / $160.66	Professional	26	$63.07	$117.27	$160.66
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $140.13 / $254.40 / $339.18	Professional	TC	$140.13	$254.40	$339.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $282.17 / $397.76 / $624.79	Professional		$282.17	$397.76	$624.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.54 / $111.59 / $173.60	Professional	26	$85.54	$111.59	$173.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $201.50 / $284.56 / $460.92	Professional	TC	$201.50	$284.56	$460.92
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $12.00 / $287.50 / $432.77	Professional		$12.00	$287.50	$432.77
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.80 / $126.26 / $127.72	Professional	26	$95.80	$126.26	$127.72
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $230.81 / $306.50 / $319.80	Professional	TC	$230.81	$306.50	$319.80
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $88.77 / $88.77 / $117.86	Facility	26	$88.77	$88.77	$117.86
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $271.75 / $366.87 / $967.63	Professional		$271.75	$366.87	$967.63
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $74.68 / $91.51 / $161.63	Professional	26	$74.68	$91.51	$161.63
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $194.74 / $251.22 / $464.42	Professional	TC	$194.74	$251.22	$464.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $418.30 / $827.50	Professional		$3.00	$418.30	$827.50
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $282.17 / $399.11 / $677.21	Professional		$282.17	$399.11	$677.21
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.24 / $117.05 / $193.61	Professional	26	$88.24	$117.05	$193.61
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $200.69 / $288.19 / $483.60	Professional	TC	$200.69	$288.19	$483.60
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $82.45 / $82.45 / $118.75	Facility	26	$82.45	$82.45	$118.75
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $285.45 / $289.52 / $321.89	Professional		$285.45	$289.52	$321.89
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.90 / $82.92 / $118.75	Professional	26	$79.90	$82.92	$118.75
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $202.53 / $207.07 / $227.95	Professional	TC	$202.53	$207.07	$227.95
United Facility/Professional Professional Modifier Low / Median / High Price $267.32 / $356.27 / $608.61	Professional		$267.32	$356.27	$608.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.88 / $105.62 / $175.71	Professional	26	$82.88	$105.62	$175.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.47 / $252.35 / $414.84	Professional	TC	$188.47	$252.35	$414.84