Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.89 / $82.21 / $164.00	Facility	26	$59.89	$82.21	$164.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.99 / $237.07 / $813.24	Professional		$164.99	$237.07	$813.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $62.19 / $184.12	Professional	26	$52.78	$62.19	$184.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.57 / $143.44 / $299.64	Professional	TC	$107.57	$143.44	$299.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.55 / $59.90 / $90.22	Professional	26	$44.55	$59.90	$90.22
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $167.69 / $174.02 / $277.83	Professional		$167.69	$174.02	$277.83
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $57.72 / $59.90 / $114.02	Professional	26	$57.72	$59.90	$114.02
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $109.98 / $114.13 / $301.08	Professional	TC	$109.98	$114.13	$301.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.19 / $318.89 / $559.55	Professional		$158.19	$318.89	$559.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.16 / $70.48 / $115.95	Professional	26	$42.16	$70.48	$115.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.52 / $218.81 / $433.58	Professional	TC	$110.52	$218.81	$433.58
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $201.71 / $267.52 / $806.48	Professional		$201.71	$267.52	$806.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.20 / $75.84 / $119.66	Professional	26	$63.20	$75.84	$119.66
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.63 / $163.85 / $233.35	Professional	TC	$131.63	$163.85	$233.35
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $472.70 / $472.70 / $472.70	Facility	26	$472.70	$472.70	$472.70
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.52 / $71.87 / $110.46	Professional	26	$64.52	$71.87	$110.46
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $58.52 / $84.39 / $203.57	Facility	26	$58.52	$84.39	$203.57
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $165.62 / $238.88 / $789.93	Professional		$165.62	$238.88	$789.93
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $75.69 / $164.64	Professional	26	$54.56	$75.69	$164.64
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $109.88 / $156.66 / $437.30	Professional	TC	$109.88	$156.66	$437.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.56 / $175.36 / $351.22	Professional		$67.56	$175.36	$351.22
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $40.17 / $66.34 / $66.34	Facility	26	$40.17	$66.34	$66.34
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $164.58 / $308.72 / $547.54	Professional		$164.58	$308.72	$547.54
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.76 / $69.69 / $117.89	Professional	26	$43.76	$69.69	$117.89
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.60 / $216.24 / $416.71	Professional	TC	$110.60	$216.24	$416.71
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.40 / $57.40 / $65.50	Facility	26	$57.40	$57.40	$65.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $167.28 / $169.62 / $337.68	Professional		$167.28	$169.62	$337.68
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $57.46 / $65.50	Professional	26	$55.90	$57.46	$65.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $112.22 / $272.18	Professional	TC	$109.82	$112.22	$272.18
United Facility/Professional Professional Modifier Low / Median / High Price $171.15 / $251.96 / $407.27	Professional		$171.15	$251.96	$407.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.29 / $68.70 / $113.15	Professional	26	$54.29	$68.70	$113.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.95 / $166.36 / $312.36	Professional	TC	$115.95	$166.36	$312.36