Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $107.15 / $213.80	Facility	26	$54.95	$107.15	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $616.60	Professional		$169.82	$275.42	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $95.50 / $208.93	Professional	26	$54.95	$95.50	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $446.68	Professional	TC	$112.20	$186.21	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $95.50	Professional	26	$44.67	$60.26	$95.50
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $60.26 / $117.49	Professional	26	$57.54	$60.26	$117.49
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $112.20 / $331.13	Professional	TC	$109.65	$112.20	$331.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $309.03 / $549.54	Professional		$165.96	$309.03	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $120.23	Professional	26	$43.65	$72.44	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $218.78 / $398.11	Professional	TC	$112.20	$218.78	$398.11
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $288.40	Professional		$177.83	$229.09	$288.40
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $91.20	Professional	26	$57.54	$74.13	$91.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $154.88 / $194.98	Professional	TC	$120.23	$154.88	$194.98
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $257.04 / $489.78	Professional		$173.78	$257.04	$489.78
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $123.03	Professional	26	$48.98	$69.18	$123.03
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $363.08	Professional	TC	$114.82	$190.55	$363.08
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $467.74 / $467.74	Facility	26	$467.74	$467.74	$467.74
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Professional		$186.21	$186.21	$186.21
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $70.79 / $107.15	Professional	26	$64.57	$70.79	$107.15
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $102.33 / $208.93	Facility	26	$54.95	$102.33	$208.93
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $602.56	Professional		$173.78	$281.84	$602.56
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $186.21	Professional	26	$54.95	$83.18	$186.21
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $204.17 / $436.52	Professional	TC	$117.49	$204.17	$436.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $302.00 / $446.68	Professional		$95.50	$302.00	$446.68
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $66.07	Facility	26	$57.54	$57.54	$66.07
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $213.80 / $245.47	Professional		$91.20	$213.80	$245.47
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $57.54 / $58.88	Professional	26	$56.23	$57.54	$58.88
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $112.20 / $123.03	Professional	TC	$109.65	$112.20	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $407.38	Professional		$169.82	$251.19	$407.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $102.33	Professional	26	$48.98	$63.10	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $165.96 / $309.03	Professional	TC	$114.82	$165.96	$309.03