Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $181.97 / $316.23	Facility	26	$89.13	$181.97	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $380.19 / $1,548.82	Professional		$245.47	$380.19	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $316.23	Professional	26	$70.79	$117.49	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $562.34	Professional	TC	$162.18	$229.09	$562.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $72.44 / $131.83	Professional	26	$39.81	$72.44	$131.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	TC	$229.09	$229.09	$229.09
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $389.05	Professional		$389.05	$389.05	$389.05
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $114.82 / $218.78	Professional	26	$85.11	$114.82	$218.78
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $181.97 / $724.44	Professional	TC	$173.78	$181.97	$724.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $489.78 / $891.25	Professional		$263.03	$489.78	$891.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $181.97	Professional	26	$64.57	$107.15	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $363.08 / $676.08	Professional	TC	$190.55	$363.08	$676.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $354.81 / $446.68	Professional		$275.42	$354.81	$446.68
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $109.65 / $134.90	Professional	26	$85.11	$109.65	$134.90
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 $269.15 / $398.11 / $794.33	Professional		$269.15	$398.11	$794.33
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $104.71 / $190.55	Professional	26	$75.86	$104.71	$190.55
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $288.40 / $562.34	Professional	TC	$181.97	$288.40	$562.34
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $407.38 / $407.38	Professional		$363.08	$407.38	$407.38
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $102.33 / $131.83	Professional	26	$89.13	$102.33	$131.83
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $173.78 / $309.03	Facility	26	$89.13	$173.78	$309.03
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $398.11 / $851.14	Professional		$257.04	$398.11	$851.14
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $117.49 / $251.19	Professional	26	$79.43	$117.49	$251.19
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $281.84 / $602.56	Professional	TC	$169.82	$281.84	$602.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $323.59 / $707.95	Professional		$141.25	$323.59	$707.95
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $97.72	Facility	26	$85.11	$85.11	$97.72
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $251.19 / $309.03	Professional		$181.97	$251.19	$309.03
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $85.11 / $97.72	Professional	26	$83.18	$85.11	$97.72
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $169.82 / $288.40	Professional	TC	$165.96	$169.82	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $398.11 / $645.65	Professional		$281.84	$398.11	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $95.50 / $151.36	Professional	26	$74.13	$95.50	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $281.84 / $512.86	Professional	TC	$199.53	$281.84	$512.86