Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $239.88 / $338.84	Facility	26	$91.20	$239.88	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $151.36 / $354.81	Professional		$120.23	$151.36	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $54.95 / $134.90	Professional	TC	$41.69	$54.95	$134.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $147.91 / $257.04	Professional		$144.54	$147.91	$257.04
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $53.70 / $87.10	Professional	TC	$51.29	$53.70	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $181.97 / $295.12	Professional		$114.82	$181.97	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $70.79 / $123.03	Professional	TC	$41.69	$70.79	$123.03
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $190.55 / $239.88	Professional		$186.21	$190.55	$239.88
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $72.44 / $91.20	Professional	TC	$67.61	$72.44	$91.20
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $194.98 / $302.00	Professional		$147.91	$194.98	$302.00
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $81.28 / $123.03	Professional	TC	$58.88	$81.28	$123.03
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $199.53 / $309.03	Facility	26	$91.20	$199.53	$309.03
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $436.52	Professional		$123.03	$177.83	$436.52
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $158.49	Professional	TC	$43.65	$64.57	$158.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $257.04 / $295.12	Professional		$218.78	$257.04	$295.12
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $107.15	Facility	26	$93.33	$93.33	$107.15
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $141.25 / $309.03	Professional		$91.20	$141.25	$309.03
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $56.23	Professional	TC	$50.12	$50.12	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $275.42	Professional		$131.83	$169.82	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $61.66 / $100.00	Professional	TC	$43.65	$61.66	$100.00