Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $575.44 / $575.44	Facility	26	$199.53	$575.44	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $363.08 / $741.31	Professional		$295.12	$363.08	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $295.12 / $724.44	Professional	26	$112.20	$295.12	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $229.09 / $436.52	Professional	TC	$181.97	$229.09	$436.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $199.53 / $263.03	Professional	26	$66.07	$199.53	$263.03
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $426.58 / $741.31	Professional		$354.81	$426.58	$741.31
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $186.21 / $281.84	Professional	26	$141.25	$186.21	$281.84
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $288.40 / $489.78	Professional	TC	$134.90	$288.40	$489.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $177.83 / $251.19	Facility	26	$38.02	$177.83	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $218.78 / $549.54	Professional		$147.91	$218.78	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $199.53	Professional	26	$64.57	$93.33	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $138.04 / $354.81	Professional	TC	$77.62	$138.04	$354.81
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $575.44 / $758.58	Professional		$316.23	$575.44	$758.58
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $190.55 / $251.19	Professional	26	$100.00	$190.55	$251.19
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $380.19 / $501.19	Professional	TC	$213.80	$380.19	$501.19
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $467.74 / $676.08	Professional		$213.80	$467.74	$676.08
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $169.82 / $288.40	Professional	26	$123.03	$169.82	$288.40
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $281.84 / $446.68	Professional	TC	$95.50	$281.84	$446.68
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $151.36 / $234.42	Professional	26	$138.04	$151.36	$234.42
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $575.44 / $575.44	Facility	26	$199.53	$575.44	$575.44
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $416.87 / $1,023.29	Professional		$295.12	$416.87	$1,023.29
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $199.53 / $549.54	Professional	26	$109.65	$199.53	$549.54
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $275.42 / $691.83	Professional	TC	$204.17	$275.42	$691.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $741.31 / $851.14	Professional		$630.96	$741.31	$851.14
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $239.88 / $467.74	Professional		$35.48	$239.88	$467.74
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $144.54	Professional	26	$138.04	$138.04	$144.54
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $275.42 / $309.03	Professional	TC	$102.33	$275.42	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $407.38 / $630.96	Professional		$181.97	$407.38	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $147.91 / $239.88	Professional	26	$79.43	$147.91	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $257.04 / $416.87	Professional	TC	$141.25	$257.04	$416.87