Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $112.20 / $204.17	Facility	26	$54.95	$112.20	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $194.98 / $549.54	Professional		$81.28	$194.98	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $100.00 / $229.09	Professional	26	$53.70	$100.00	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $426.58	Professional	TC	$112.20	$186.21	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $194.98	Professional		$147.91	$147.91	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $74.13 / $102.33	Professional	26	$41.69	$74.13	$102.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $144.54	Professional	TC	$102.33	$102.33	$144.54
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $269.15 / $478.63	Professional		$162.18	$269.15	$478.63
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $134.90	Professional	26	$54.95	$70.79	$134.90
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $371.54	Professional	TC	$109.65	$190.55	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $302.00 / $501.19	Professional		$162.18	$302.00	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $67.61 / $114.82	Professional	26	$41.69	$67.61	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $218.78 / $380.19	Professional	TC	$112.20	$218.78	$380.19
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $281.84	Professional		$173.78	$223.87	$281.84
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $87.10	Professional	26	$54.95	$70.79	$87.10
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 $169.82 / $239.88 / $489.78	Professional		$169.82	$239.88	$489.78
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $66.07 / $117.49	Professional	26	$46.77	$66.07	$117.49
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $177.83 / $363.08	Professional	TC	$114.82	$177.83	$363.08
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $213.80 / $223.87	Professional		$181.97	$213.80	$223.87
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $67.61 / $107.15	Professional	26	$61.66	$67.61	$107.15
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $204.17 / $213.80	Professional	TC	$204.17	$204.17	$213.80
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $102.33 / $199.53	Facility	26	$54.95	$102.33	$199.53
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $269.15 / $575.44	Professional		$154.88	$269.15	$575.44
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $181.97	Professional	26	$52.48	$81.28	$181.97
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $426.58	Professional	TC	$117.49	$208.93	$426.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $316.23 / $446.68	Professional		$63.10	$316.23	$446.68
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $61.66 / $61.66	Facility	26	$54.95	$61.66	$61.66
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $181.97 / $288.40	Professional		$50.12	$181.97	$288.40
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $56.23 / $61.66	Professional	26	$52.48	$56.23	$61.66
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $123.03 / $229.09	Professional	TC	$109.65	$123.03	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $389.05	Professional		$165.96	$239.88	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $97.72	Professional	26	$46.77	$60.26	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $165.96 / $302.00	Professional	TC	$112.20	$165.96	$302.00