Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.97 / $63.94 / $95.00	Facility	26	$47.97	$63.94	$95.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $138.84 / $252.95	Professional		$109.45	$138.84	$252.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.09 / $47.36 / $104.00	Professional	26	$33.09	$47.36	$104.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.42 / $97.58 / $177.61	Professional	TC	$79.42	$97.58	$177.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.93 / $45.62 / $86.42	Professional	26	$36.93	$45.62	$86.42
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $146.27 / $170.21 / $265.93	Professional		$146.27	$170.21	$265.93
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $48.69 / $57.13 / $81.70	Professional	26	$48.69	$57.13	$81.70
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $97.57 / $108.98 / $201.06	Professional	TC	$97.57	$108.98	$201.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.98 / $55.98 / $55.98	Facility	26	$55.98	$55.98	$55.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.39 / $172.01 / $286.43	Professional		$110.39	$172.01	$286.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.15 / $45.93 / $86.48	Professional	26	$32.15	$45.93	$86.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.56 / $122.79 / $200.25	Professional	TC	$72.56	$122.79	$200.25
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $154.47 / $194.42 / $239.52	Professional		$154.47	$194.42	$239.52
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $63.95 / $101.09	Professional	26	$53.20	$63.95	$101.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.75 / $145.43 / $207.17	Professional	TC	$116.75	$145.43	$207.17
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.01 / $55.37 / $83.06	Professional	26	$40.01	$55.37	$83.06
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $47.97 / $65.78 / $151.62	Facility	26	$47.97	$65.78	$151.62
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $125.86 / $159.54 / $301.52	Professional		$125.86	$159.54	$301.52
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $34.93 / $56.42 / $102.42	Professional	26	$34.93	$56.42	$102.42
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $89.24 / $111.56 / $226.44	Professional	TC	$89.24	$111.56	$226.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $125.80 / $134.19 / $346.80	Professional		$125.80	$134.19	$346.80
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $22.69 / $55.98 / $55.98	Facility	26	$22.69	$55.98	$55.98
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $110.86 / $172.48 / $279.14	Professional		$110.86	$172.48	$279.14
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $45.93 / $84.95	Professional	26	$32.86	$45.93	$84.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.77 / $123.48 / $198.83	Professional	TC	$73.77	$123.48	$198.83
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $37.50 / $48.49 / $48.49	Facility	26	$37.50	$48.49	$48.49
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $135.50 / $149.97 / $161.94	Professional		$135.50	$149.97	$161.94
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $37.50 / $48.49 / $50.24	Professional	26	$37.50	$48.49	$50.24
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $98.00 / $101.48 / $111.71	Professional	TC	$98.00	$101.48	$111.71
United Facility/Professional Professional Modifier Low / Median / High Price $106.74 / $158.94 / $287.23	Professional		$106.74	$158.94	$287.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $52.12 / $95.70	Professional	26	$34.06	$52.12	$95.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.79 / $113.97 / $192.92	Professional	TC	$86.79	$113.97	$192.92