Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $83.18 / $158.49	Facility	26	$41.69	$83.18	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $199.53 / $602.56	Professional		$109.65	$199.53	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $77.62 / $194.98	Professional	26	$42.66	$77.62	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $91.20 / $323.59	Professional	TC	$57.54	$91.20	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $173.78	Professional		$77.62	$95.50	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $64.57 / $89.13	Professional	26	$37.15	$64.57	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $54.95 / $67.61	Professional	TC	$46.77	$54.95	$67.61
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $147.91 / $288.40	Professional		$112.20	$147.91	$288.40
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $117.49	Professional	26	$46.77	$60.26	$117.49
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $85.11 / $173.78	Professional	TC	$66.07	$85.11	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $144.54 / $239.88	Professional		$95.50	$144.54	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.88 / $93.33	Professional	26	$38.02	$58.88	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $89.13 / $141.25	Professional	TC	$56.23	$89.13	$141.25
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $162.18 / $199.53	Professional		$138.04	$162.18	$199.53
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $61.66 / $75.86	Professional	26	$39.81	$61.66	$75.86
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $97.72 / $123.03	Professional	TC	$61.66	$97.72	$123.03
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $151.36 / $245.47	Professional		$102.33	$151.36	$245.47
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $60.26 / $95.50	Professional	26	$40.74	$60.26	$95.50
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $144.54	Professional	TC	$60.26	$91.20	$144.54
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $138.04 / $190.55	Professional		$128.82	$138.04	$190.55
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $56.23 / $79.43	Professional	26	$48.98	$56.23	$79.43
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $102.33 / $109.65	Professional	TC	$81.28	$102.33	$109.65
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $154.88 / $245.47	Professional		$151.36	$154.88	$245.47
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $72.44 / $158.49	Facility	26	$41.69	$72.44	$158.49
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $173.78 / $380.19	Professional		$104.71	$173.78	$380.19
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $147.91	Professional	26	$41.69	$66.07	$147.91
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $177.83	Professional	TC	$61.66	$91.20	$177.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $177.83 / $251.19	Professional		$87.10	$177.83	$251.19
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $57.54	Facility	26	$57.54	$57.54	$57.54
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $87.10 / $309.03	Professional		$51.29	$87.10	$309.03
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	26	$57.54	$57.54	$57.54
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $75.86	Professional	TC	$75.86	$75.86	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $199.53	Professional		$91.20	$125.89	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.29 / $83.18	Professional	26	$38.90	$51.29	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $75.86 / $123.03	Professional	TC	$57.54	$75.86	$123.03