Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $419.44 / $494.94 / $494.94	Facility	26	$419.44	$494.94	$494.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.78 / $189.38 / $273.63	Professional		$129.78	$189.38	$273.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.88 / $102.58 / $140.58	Professional	26	$75.88	$102.58	$140.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.90 / $91.28 / $133.05	Professional	TC	$53.90	$91.28	$133.05
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $232.03 / $240.79 / $393.52	Professional		$232.03	$240.79	$393.52
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $119.21 / $123.71 / $209.51	Professional	26	$119.21	$123.71	$209.51
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $112.83 / $117.08 / $173.43	Professional	TC	$112.83	$117.08	$173.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.13 / $138.13 / $138.13	Facility	26	$138.13	$138.13	$138.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $157.66 / $360.73	Professional		$109.45	$157.66	$360.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.36 / $193.18	Professional	26	$56.23	$79.36	$193.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.51 / $79.20 / $169.28	Professional	TC	$50.51	$79.20	$169.28
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $147.66 / $338.44 / $446.11	Professional		$147.66	$338.44	$446.11
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.94 / $163.72 / $214.53	Professional	26	$71.94	$163.72	$214.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.73 / $176.00 / $234.83	Professional	TC	$75.73	$176.00	$234.83
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $494.94 / $494.94 / $494.94	Facility	26	$494.94	$494.94	$494.94
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $157.61 / $194.17 / $932.22	Professional		$157.61	$194.17	$932.22
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $79.78 / $102.89 / $494.94	Professional	26	$79.78	$102.89	$494.94
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $76.64 / $91.54 / $437.28	Professional	TC	$76.64	$91.54	$437.28
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $106.81 / $203.03 / $397.37	Professional		$106.81	$203.03	$397.37
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $138.13 / $138.13 / $138.13	Facility	26	$138.13	$138.13	$138.13
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $198.18 / $354.76	Professional		$109.45	$198.18	$354.76
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $112.65 / $194.93	Professional	26	$56.23	$112.65	$194.93
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.83 / $82.68 / $172.27	Professional	TC	$50.83	$82.68	$172.27
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $223.14 / $230.23 / $287.77	Professional		$223.14	$230.23	$287.77
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $119.40 / $122.24 / $161.69	Professional	26	$119.40	$122.24	$161.69
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $103.74 / $108.00 / $126.08	Professional	TC	$103.74	$108.00	$126.08
United Facility/Professional Professional Modifier Low / Median / High Price $139.16 / $231.66 / $356.08	Professional		$139.16	$231.66	$356.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.33 / $131.86 / $197.79	Professional	26	$74.33	$131.86	$197.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.84 / $99.80 / $185.20	Professional	TC	$64.84	$99.80	$185.20