Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $204.17 / $426.58	Facility	26	$109.65	$204.17	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $549.54 / $2,398.83	Professional		$331.13	$549.54	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $208.93 / $512.86	Professional	26	$107.15	$208.93	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $870.96	Professional	TC	$218.78	$338.84	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $281.84 / $436.52	Professional		$257.04	$281.84	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $154.88 / $204.17	Professional	26	$97.72	$154.88	$204.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $190.55 / $275.42	Professional	TC	$117.49	$190.55	$275.42
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $1,230.27	Professional		$331.13	$501.19	$1,230.27
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $154.88 / $281.84	Professional	26	$114.82	$154.88	$281.84
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $331.13 / $1,122.02	Professional	TC	$218.78	$331.13	$1,122.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $123.03 / $177.83	Facility	26	$26.92	$123.03	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $630.96 / $1,318.26	Professional		$309.03	$630.96	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $144.54 / $245.47	Professional	26	$81.28	$144.54	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $446.68 / $1,096.48	Professional	TC	$208.93	$446.68	$1,096.48
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $446.68 / $1,445.44	Professional		$338.84	$446.68	$1,445.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $141.25 / $173.78	Professional	26	$107.15	$141.25	$173.78
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $295.12 / $371.54	Professional	TC	$229.09	$295.12	$371.54
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $562.34 / $1,047.13	Professional		$331.13	$562.34	$1,047.13
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $257.04	Professional	26	$102.33	$138.04	$257.04
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $426.58 / $794.33	Professional	TC	$213.80	$426.58	$794.33
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $407.38 / $645.65	Professional		$371.54	$407.38	$645.65
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $134.90 / $190.55	Professional	26	$120.23	$134.90	$190.55
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $398.11 / $1,000.00	Professional	TC	$389.05	$398.11	$1,000.00
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $194.98 / $416.87	Facility	26	$109.65	$194.98	$416.87
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $537.03 / $1,479.11	Professional		$354.81	$537.03	$1,479.11
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $173.78 / $371.54	Professional	26	$109.65	$173.78	$371.54
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $363.08 / $851.14	Professional	TC	$229.09	$363.08	$851.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $562.34 / $741.31	Professional		$120.23	$562.34	$741.31
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $676.08 / $691.83	Professional		$74.13	$676.08	$691.83
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $107.15 / $112.20	Professional	26	$104.71	$107.15	$112.20
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $213.80 / $234.42	Professional	TC	$208.93	$213.80	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $467.74 / $1,071.52	Professional		$316.23	$467.74	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $123.03 / $208.93	Professional	26	$97.72	$123.03	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $309.03 / $891.25	Professional	TC	$208.93	$309.03	$891.25