Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.50 / $72.87 / $174.45	Facility	26	$53.50	$72.87	$174.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.96 / $285.80 / $796.86	Professional		$171.96	$285.80	$796.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.88 / $68.64 / $180.25	Professional	26	$49.88	$68.64	$180.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $122.07 / $166.06 / $355.65	Professional	TC	$122.07	$166.06	$355.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.00 / $140.51 / $173.78	Professional		$109.00	$140.51	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $55.33 / $87.95	Professional	26	$40.47	$55.33	$87.95
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $177.32 / $184.01 / $489.01	Professional		$177.32	$184.01	$489.01
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $53.36 / $55.37 / $129.09	Professional	26	$53.36	$55.37	$129.09
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $123.96 / $128.63 / $359.92	Professional	TC	$123.96	$128.63	$359.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $179.99 / $327.93 / $594.23	Professional		$179.99	$327.93	$594.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.21 / $73.97 / $124.33	Professional	26	$42.21	$73.97	$124.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.63 / $242.68 / $451.63	Professional	TC	$128.63	$242.68	$451.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $214.04 / $284.02 / $841.79	Professional		$214.04	$284.02	$841.79
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.39 / $70.13 / $110.70	Professional	26	$58.39	$70.13	$110.70
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.36 / $184.70 / $263.08	Professional	TC	$148.36	$184.70	$263.08
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.39 / $229.39 / $229.42	Professional		$229.39	$229.39	$229.42
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.64 / $66.43 / $100.10	Professional	26	$59.64	$66.43	$100.10
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $53.50 / $76.01 / $185.62	Facility	26	$53.50	$76.01	$185.62
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $175.66 / $264.13 / $852.65	Professional		$175.66	$264.13	$852.65
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $50.96 / $70.70 / $177.97	Professional	26	$50.96	$70.70	$177.97
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $124.70 / $168.45 / $494.57	Professional	TC	$124.70	$168.45	$494.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.51 / $207.11 / $370.10	Professional		$75.51	$207.11	$370.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $45.13 / $61.34 / $61.34	Facility	26	$45.13	$61.34	$61.34
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $184.01 / $326.33 / $594.23	Professional		$184.01	$326.33	$594.23
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.43 / $74.45 / $124.33	Professional	26	$44.43	$74.45	$124.33
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.63 / $238.20 / $451.63	Professional	TC	$128.63	$238.20	$451.63
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $53.10 / $53.10 / $75.00	Facility	26	$53.10	$53.10	$75.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $177.47 / $180.18 / $362.50	Professional		$177.47	$180.18	$362.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $51.73 / $53.12 / $75.00	Professional	26	$51.73	$53.12	$75.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $124.34 / $127.08 / $287.50	Professional	TC	$124.34	$127.08	$287.50
United Facility/Professional Professional Modifier Low / Median / High Price $193.79 / $272.39 / $474.47	Professional		$193.79	$272.39	$474.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.05 / $65.67 / $111.99	Professional	26	$51.05	$65.67	$111.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $137.97 / $196.66 / $373.79	Professional	TC	$137.97	$196.66	$373.79