Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $169.82 / $263.03	Facility	26	$67.61	$169.82	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $660.69	Professional		$190.55	$275.42	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $158.49	Professional	26	$52.48	$72.44	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $208.93 / $549.54	Professional	TC	$134.90	$208.93	$549.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $131.83	Professional		$131.83	$131.83	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $56.23 / $85.11	Professional	26	$45.71	$56.23	$85.11
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $489.78 / $489.78	Professional		$338.84	$489.78	$489.78
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $61.66 / $117.49	Professional	26	$60.26	$61.66	$117.49
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $138.04 / $389.05	Professional	TC	$134.90	$138.04	$389.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $380.19 / $645.65	Professional		$199.53	$380.19	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $74.13 / $125.89	Professional	26	$45.71	$74.13	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $275.42 / $501.19	Professional	TC	$138.04	$275.42	$501.19
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $269.15 / $331.13	Professional		$208.93	$269.15	$331.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $95.50	Professional	26	$58.88	$77.62	$95.50
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $190.55 / $239.88	Professional	TC	$147.91	$190.55	$239.88
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $309.03 / $588.84	Professional		$204.17	$309.03	$588.84
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $125.89	Professional	26	$51.29	$70.79	$125.89
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $239.88 / $457.09	Professional	TC	$141.25	$239.88	$457.09
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $67.61 / $93.33	Professional	26	$63.10	$67.61	$93.33
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $158.49 / $251.19	Facility	26	$74.13	$158.49	$251.19
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $676.08	Professional		$194.98	$316.23	$676.08
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $158.49	Professional	26	$54.95	$79.43	$158.49
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $229.09 / $549.54	Professional	TC	$138.04	$229.09	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $323.59 / $537.03	Professional		$100.00	$323.59	$537.03
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $69.18 / $69.18	Facility	26	$60.26	$69.18	$69.18
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $218.78 / $407.38	Professional		$194.98	$218.78	$407.38
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $69.18	Professional	26	$60.26	$60.26	$69.18
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $141.25 / $338.84	Professional	TC	$134.90	$141.25	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $295.12 / $489.78	Professional		$194.98	$295.12	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $107.15	Professional	26	$50.12	$66.07	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $204.17 / $389.05	Professional	TC	$141.25	$204.17	$389.05