Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $72.44 / $177.83	Facility	26	$38.90	$72.44	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $263.03 / $891.25	Professional		$128.82	$263.03	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $194.98	Professional	26	$38.02	$60.26	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $151.36 / $426.58	Professional	TC	$87.10	$151.36	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $102.33 / $131.83	Professional		$85.11	$102.33	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $38.90 / $67.61	Professional	26	$31.62	$38.90	$67.61
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $79.43 / $131.83	Professional	TC	$58.88	$79.43	$131.83
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $218.78 / $331.13	Professional		$131.83	$218.78	$331.13
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $66.07 / $104.71	Professional	26	$42.66	$66.07	$104.71
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $398.11	Professional	TC	$91.20	$147.91	$398.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $66.07	Facility	26	$10.00	$46.77	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $234.42 / $407.38	Professional		$123.03	$234.42	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $58.88 / $100.00	Professional	26	$33.88	$58.88	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $165.96 / $302.00	Professional	TC	$81.28	$165.96	$302.00
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $218.78	Professional		$134.90	$173.78	$218.78
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $52.48 / $64.57	Professional	26	$40.74	$52.48	$64.57
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $151.36	Professional	TC	$95.50	$123.03	$151.36
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $380.19	Professional		$131.83	$190.55	$380.19
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $107.15	Professional	26	$42.66	$54.95	$107.15
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $138.04 / $288.40	Professional	TC	$89.13	$138.04	$288.40
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $154.88 / $269.15	Professional		$144.54	$154.88	$269.15
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $50.12 / $72.44	Professional	26	$44.67	$50.12	$72.44
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $165.96	Professional	TC	$134.90	$158.49	$165.96
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $50.12 / $66.07	Professional	26	$45.71	$50.12	$66.07
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $67.61 / $177.83	Facility	26	$40.74	$67.61	$177.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $234.42 / $562.34	Professional		$134.90	$234.42	$562.34
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $61.66 / $162.18	Professional	26	$38.90	$61.66	$162.18
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $151.36 / $316.23	Professional	TC	$91.20	$151.36	$316.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $323.59 / $389.05	Professional		$81.28	$323.59	$389.05
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $39.81 / $66.07	Facility	26	$39.81	$39.81	$66.07
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $125.89 / $407.38	Professional		$40.74	$125.89	$407.38
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $39.81 / $66.07	Professional	26	$38.90	$39.81	$66.07
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $87.10 / $199.53	Professional	TC	$85.11	$87.10	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $181.97 / $309.03	Professional		$120.23	$181.97	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $48.98 / $79.43	Professional	26	$37.15	$48.98	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $117.49 / $223.87	Professional	TC	$81.28	$117.49	$223.87