Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $123.03 / $245.47	Facility	26	$63.10	$123.03	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $371.54 / $1,479.11	Professional		$234.42	$371.54	$1,479.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $213.80	Professional	26	$61.66	$93.33	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $776.25	Professional	TC	$162.18	$257.04	$776.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $208.93 / $331.13	Professional		$173.78	$208.93	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $67.61 / $100.00	Professional	26	$50.12	$67.61	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $165.96 / $251.19	Professional	TC	$162.18	$165.96	$251.19
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $870.96	Professional		$870.96	$870.96	$870.96
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $162.18	Professional	26	$66.07	$85.11	$162.18
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $263.03 / $691.83	Professional	TC	$173.78	$263.03	$691.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $107.15	Facility	26	$16.22	$75.86	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $416.87 / $724.44	Professional		$234.42	$416.87	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $138.04	Professional	26	$50.12	$83.18	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $309.03 / $575.44	Professional	TC	$169.82	$309.03	$575.44
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $331.13 / $416.87	Professional		$257.04	$331.13	$416.87
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $85.11 / $104.71	Professional	26	$64.57	$85.11	$104.71
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $245.47 / $309.03	Professional	TC	$190.55	$245.47	$309.03
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $338.84 / $645.65	Professional		$251.19	$338.84	$645.65
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $144.54	Professional	26	$56.23	$79.43	$144.54
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $257.04 / $512.86	Professional	TC	$181.97	$257.04	$512.86
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $331.13 / $407.38	Professional		$288.40	$331.13	$407.38
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $77.62 / $100.00	Professional	26	$74.13	$77.62	$100.00
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	TC	$354.81	$354.81	$354.81
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $114.82 / $234.42	Facility	26	$63.10	$114.82	$234.42
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $380.19 / $812.83	Professional		$234.42	$380.19	$812.83
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $89.13 / $190.55	Professional	26	$63.10	$89.13	$190.55
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $281.84 / $549.54	Professional	TC	$169.82	$281.84	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $323.59 / $512.86	Professional		$109.65	$323.59	$512.86
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $75.86 / $75.86	Facility	26	$66.07	$75.86	$75.86
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $245.47 / $371.54	Professional		$64.57	$245.47	$371.54
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $66.07 / $75.86	Professional	26	$63.10	$66.07	$75.86
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $173.78 / $323.59	Professional	TC	$165.96	$173.78	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $338.84 / $537.03	Professional		$239.88	$338.84	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $117.49	Professional	26	$56.23	$72.44	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $251.19 / $446.68	Professional	TC	$177.83	$251.19	$446.68