Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.62 / $108.41 / $286.36	Facility	26	$90.62	$108.41	$286.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $121.53 / $142.81 / $246.65	Professional		$121.53	$142.81	$246.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.83 / $52.67 / $92.77	Professional	TC	$42.83	$52.67	$92.77
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $143.47 / $148.90 / $261.54	Professional		$143.47	$148.90	$261.54
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $51.17 / $53.10 / $86.32	Professional	TC	$51.17	$53.10	$86.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.07 / $106.07 / $106.07	Facility	26	$106.07	$106.07	$106.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.42 / $184.15 / $294.80	Professional		$116.42	$184.15	$294.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.23 / $70.43 / $122.93	Professional	TC	$42.23	$70.43	$122.93
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.13 / $208.75 / $220.05	Professional		$162.13	$208.75	$220.05
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.31 / $76.18 / $85.23	Professional	TC	$61.31	$76.18	$85.23
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $90.62 / $165.84 / $296.33	Facility	26	$90.62	$165.84	$296.33
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $128.77 / $164.61 / $308.67	Professional		$128.77	$164.61	$308.67
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $45.37 / $61.51 / $114.74	Professional	TC	$45.37	$61.51	$114.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $175.56 / $293.98	Professional		$81.28	$175.56	$293.98
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $106.07 / $106.07 / $106.07	Facility	26	$106.07	$106.07	$106.07
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $116.42 / $194.66 / $295.37	Professional		$116.42	$194.66	$295.37
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $43.54 / $74.11 / $119.67	Professional	TC	$43.54	$74.11	$119.67
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $92.28 / $92.28 / $106.50	Facility	26	$92.28	$92.28	$106.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $140.34 / $142.85 / $215.00	Professional		$140.34	$142.85	$215.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $49.55 / $50.57 / $108.50	Professional	TC	$49.55	$50.57	$108.50
United Facility/Professional Professional Modifier Low / Median / High Price $132.82 / $177.60 / $278.97	Professional		$132.82	$177.60	$278.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.84 / $63.32 / $101.45	Professional	TC	$43.84	$63.32	$101.45