Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.55 / $118.81 / $195.53	Facility	26	$114.55	$118.81	$195.53
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $144.85 / $172.19 / $172.19	Facility	53	$144.85	$172.19	$172.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $704.49 / $954.60 / $4,359.00	Professional		$704.49	$954.60	$4,359.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.84 / $187.33 / $649.47	Professional	26	$106.84	$187.33	$649.47
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $380.81 / $516.04	Professional	52	$335.54	$380.81	$516.04
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $152.32 / $206.42	Professional	53	$134.22	$152.32	$206.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $582.66 / $729.29 / $1,120.58	Professional	TC	$582.66	$729.29	$1,120.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $512.57 / $1,028.19 / $1,028.19	Professional		$512.57	$1,028.19	$1,028.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.57 / $182.39 / $182.39	Professional	26	$84.57	$182.39	$182.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $669.58 / $694.85 / $1,594.76	Professional		$669.58	$694.85	$1,594.76
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $110.49 / $178.60 / $424.99	Professional	26	$110.49	$178.60	$424.99
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $559.09 / $580.17 / $1,271.31	Professional	TC	$559.09	$580.17	$1,271.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $126.71	Facility	26	$126.71	$126.71	$126.71
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $686.09 / $1,046.66 / $1,634.92	Professional		$686.09	$1,046.66	$1,634.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.24 / $195.01 / $318.23	Professional	26	$104.24	$195.01	$318.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $568.54 / $841.93 / $1,358.02	Professional	TC	$568.54	$841.93	$1,358.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $817.71 / $1,055.27 / $1,398.48	Professional		$817.71	$1,055.27	$1,398.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $124.01 / $159.44 / $226.92	Professional	26	$124.01	$159.44	$226.92
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $692.27 / $895.83 / $1,171.56	Professional	TC	$692.27	$895.83	$1,171.56
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $106.84 / $118.81 / $217.56	Facility	26	$106.84	$118.81	$217.56
Martin's Point Facility/Professional Facility Modifier 53 Low / Median / High Price $172.19 / $172.19 / $172.19	Facility	53	$172.19	$172.19	$172.19
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $724.24 / $1,036.04 / $4,352.00	Professional		$724.24	$1,036.04	$4,352.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $109.09 / $187.33 / $564.62	Professional	26	$109.09	$187.33	$564.62
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $335.54 / $384.37 / $2,346.23	Professional	52	$335.54	$384.37	$2,346.23
Martin's Point Facility/Professional Professional Modifier 53 Low / Median / High Price $134.22 / $156.34 / $436.02	Professional	53	$134.22	$156.34	$436.02
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $617.38 / $796.43 / $1,647.48	Professional	TC	$617.38	$796.43	$1,647.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,196.90 / $1,196.90 / $2,149.30	Professional		$1,196.90	$1,196.90	$2,149.30
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $126.71 / $126.71 / $186.77	Facility	26	$126.71	$126.71	$186.77
Priority Health Facility/Professional Facility Modifier 53 Low / Median / High Price $163.30 / $163.30 / $163.30	Facility	53	$163.30	$163.30	$163.30
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $694.84 / $1,049.47 / $1,676.87	Professional		$694.84	$1,049.47	$1,676.87
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.24 / $198.45 / $334.25	Professional	26	$104.24	$198.45	$334.25
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $580.17 / $841.93 / $1,392.16	Professional	TC	$580.17	$841.93	$1,392.16
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $109.04 / $109.04 / $224.50	Facility	26	$109.04	$109.04	$224.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $697.20 / $711.01 / $952.16	Professional		$697.20	$711.01	$952.16
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $106.62 / $109.04 / $224.50	Professional	26	$106.62	$109.04	$224.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $588.48 / $601.97 / $727.66	Professional	TC	$588.48	$601.97	$727.66
United Facility/Professional Professional Modifier Low / Median / High Price $748.34 / $953.83 / $1,638.40	Professional		$748.34	$953.83	$1,638.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.37 / $157.41 / $264.18	Professional	26	$117.37	$157.41	$264.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $619.15 / $806.54 / $1,400.80	Professional	TC	$619.15	$806.54	$1,400.80