Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.82 / $111.82 / $155.40	Facility	26	$111.82	$111.82	$155.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.13 / $350.44 / $469.79	Professional		$277.13	$350.44	$469.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.83 / $105.17 / $137.65	Professional	26	$83.83	$105.17	$137.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $178.79 / $242.74 / $315.58	Professional	TC	$178.79	$242.74	$315.58
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $329.79 / $342.23 / $342.23	Professional		$329.79	$342.23	$342.23
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $104.75 / $168.59 / $215.67	Professional	26	$104.75	$168.59	$215.67
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $225.03 / $335.35 / $407.02	Professional	TC	$225.03	$335.35	$407.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.52 / $420.01 / $671.19	Professional		$316.52	$420.01	$671.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.70 / $143.22 / $221.92	Professional	26	$108.70	$143.22	$221.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.78 / $279.19 / $474.61	Professional	TC	$200.78	$279.19	$474.61
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $401.09 / $531.61 / $548.97	Professional		$401.09	$531.61	$548.97
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.37 / $158.88 / $159.91	Professional	26	$120.37	$158.88	$159.91
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $280.72 / $372.73 / $389.05	Professional	TC	$280.72	$372.73	$389.05
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $111.82 / $149.21 / $155.40	Facility	26	$111.82	$149.21	$155.40
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $325.35 / $408.99 / $1,234.00	Professional		$325.35	$408.99	$1,234.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $93.75 / $116.82 / $207.99	Professional	26	$93.75	$116.82	$207.99
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $207.65 / $289.19 / $498.37	Professional	TC	$207.65	$289.19	$498.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $361.60 / $998.00	Professional		$3.00	$361.60	$998.00
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $316.52 / $425.20 / $689.32	Professional		$316.52	$425.20	$689.32
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.25 / $146.04 / $244.07	Professional	26	$113.25	$146.04	$244.07
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.36 / $298.77 / $478.61	Professional	TC	$203.36	$298.77	$478.61
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $102.92 / $102.92 / $110.50	Facility	26	$102.92	$102.92	$110.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $286.50 / $351.41 / $380.59	Professional		$286.50	$351.41	$380.59
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $99.70 / $103.53 / $110.50	Professional	26	$99.70	$103.53	$110.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $176.00 / $248.49 / $273.54	Professional	TC	$176.00	$248.49	$273.54
United Facility/Professional Professional Modifier Low / Median / High Price $282.87 / $389.95 / $673.71	Professional		$282.87	$389.95	$673.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $106.73 / $131.84 / $215.45	Professional	26	$106.73	$131.84	$215.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.47 / $281.75 / $460.16	Professional	TC	$195.47	$281.75	$460.16