Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.30 / $40.53 / $99.01	Facility	26	$28.30	$40.53	$99.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.18 / $75.31 / $130.90	Professional		$62.18	$75.31	$130.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $30.94 / $51.26	Professional	26	$26.24	$30.94	$51.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.47 / $44.37 / $79.63	Professional	TC	$35.47	$44.37	$79.63
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $72.38 / $104.32 / $170.11	Professional		$72.38	$104.32	$170.11
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $32.01 / $44.95 / $65.84	Professional	26	$32.01	$44.95	$65.84
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $144.75 / $208.63 / $340.23	Professional	50	$144.75	$208.63	$340.23
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $58.94 / $104.27	Professional	TC	$40.36	$58.94	$104.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.28 / $109.63 / $170.13	Professional		$64.28	$109.63	$170.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.05 / $42.32 / $65.09	Professional	26	$26.05	$42.32	$65.09
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $126.81 / $126.81 / $145.44	Professional	50	$126.81	$126.81	$145.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.92 / $66.16 / $114.03	Professional	TC	$38.92	$66.16	$114.03
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $86.59 / $102.94 / $175.55	Professional		$86.59	$102.94	$175.55
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.54 / $46.45 / $72.53	Professional	26	$36.54	$46.45	$72.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.46 / $64.88 / $103.02	Professional	TC	$50.46	$64.88	$103.02
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $30.94 / $57.86 / $101.17	Facility	26	$30.94	$57.86	$101.17
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $65.29 / $87.15 / $165.08	Professional		$65.29	$87.15	$165.08
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $26.71 / $32.22 / $79.20	Professional	26	$26.71	$32.22	$79.20
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $36.71 / $51.74 / $98.31	Professional	TC	$36.71	$51.74	$98.31
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $133.19 / $133.19 / $201.70	Professional		$133.19	$133.19	$201.70
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.24 / $36.24 / $36.24	Facility	26	$36.24	$36.24	$36.24
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $68.28 / $107.86 / $170.06	Professional		$68.28	$107.86	$170.06
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.16 / $42.32 / $64.61	Professional	26	$26.16	$42.32	$64.61
Priority Health Facility/Professional Professional Modifier 50 Low / Median / High Price $126.81 / $145.44 / $145.44	Professional	50	$126.81	$145.44	$145.44
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.92 / $65.45 / $106.39	Professional	TC	$38.92	$65.45	$106.39
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $31.39 / $31.39 / $35.71	Facility	26	$31.39	$31.39	$35.71
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $71.12 / $72.17 / $127.38	Professional		$71.12	$72.17	$127.38
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.78 / $31.39 / $35.71	Professional	26	$30.78	$31.39	$35.71
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $39.92 / $40.78 / $91.67	Professional	TC	$39.92	$40.78	$91.67
United Facility/Professional Professional Modifier Low / Median / High Price $75.11 / $107.97 / $180.79	Professional		$75.11	$107.97	$180.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $37.94 / $71.08	Professional	26	$27.34	$37.94	$71.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.83 / $64.78 / $119.52	Professional	TC	$44.83	$64.78	$119.52