Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.98 / $25.87 / $39.10	Facility	26	$18.98	$25.87	$39.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.16 / $88.45 / $178.24	Professional		$72.16	$88.45	$178.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $19.75 / $45.95	Professional	26	$17.07	$19.75	$45.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $67.95 / $118.23	Professional	TC	$55.57	$67.95	$118.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.35 / $58.35 / $58.35	Professional		$58.35	$58.35	$58.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.25 / $15.50 / $31.39	Professional	26	$15.25	$15.50	$31.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $94.79 / $126.09 / $155.79	Professional		$94.79	$126.09	$155.79
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $20.10 / $32.50 / $39.04	Professional	26	$20.10	$32.50	$39.04
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $74.69 / $98.36 / $123.23	Professional	TC	$74.69	$98.36	$123.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.88 / $102.87 / $173.10	Professional		$70.88	$102.87	$173.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $24.74 / $40.06	Professional	26	$14.69	$24.74	$40.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.05 / $78.89 / $136.91	Professional	TC	$56.05	$78.89	$136.91
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $88.99 / $127.57 / $153.87	Professional		$88.99	$127.57	$153.87
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.07 / $26.53 / $41.69	Professional	26	$22.07	$26.53	$41.69
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.45 / $111.25 / $158.40	Professional	TC	$89.45	$111.25	$158.40
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.66 / $24.04 / $25.46	Professional	26	$21.66	$24.04	$25.46
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $18.98 / $26.23 / $62.41	Facility	26	$18.98	$26.23	$62.41
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $99.93 / $198.71	Professional		$73.73	$99.93	$198.71
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $21.90 / $46.75	Professional	26	$17.55	$21.90	$46.75
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $59.64 / $80.18 / $149.94	Professional	TC	$59.64	$80.18	$149.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.69 / $78.41 / $160.24	Professional		$20.69	$78.41	$160.24
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.72 / $22.72 / $22.72	Facility	26	$22.72	$22.72	$22.72
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $70.48 / $102.87 / $173.10	Professional		$70.48	$102.87	$173.10
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.69 / $24.65 / $40.06	Professional	26	$14.69	$24.65	$40.06
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.05 / $78.89 / $132.97	Professional	TC	$56.05	$78.89	$132.97
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $19.88 / $19.88 / $22.43	Facility	26	$19.88	$19.88	$22.43
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $83.96 / $95.11 / $103.48	Professional		$83.96	$95.11	$103.48
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $19.88 / $22.43	Professional	26	$19.39	$19.88	$22.43
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $61.53 / $75.23 / $82.83	Professional	TC	$61.53	$75.23	$82.83
United Facility/Professional Professional Modifier Low / Median / High Price $74.39 / $94.63 / $167.70	Professional		$74.39	$94.63	$167.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $23.04 / $38.71	Professional	26	$18.80	$23.04	$38.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.85 / $76.52 / $130.52	Professional	TC	$57.85	$76.52	$130.52