Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.09 / $39.76 / $39.76	Facility	26	$37.09	$39.76	$39.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.31 / $152.62 / $278.62	Professional		$109.31	$152.62	$278.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.09 / $43.90 / $99.29	Professional	26	$37.09	$43.90	$99.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.69 / $90.37 / $218.29	Professional	TC	$69.69	$90.37	$218.29
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $100.80 / $151.91 / $171.32	Professional		$100.80	$151.91	$171.32
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $43.18 / $85.58	Professional	26	$34.89	$43.18	$85.58
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $139.99 / $214.58 / $266.83	Professional	50	$139.99	$214.58	$266.83
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $65.23 / $110.29 / $133.13	Professional	TC	$65.23	$110.29	$133.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.14 / $47.14 / $47.14	Facility	26	$47.14	$47.14	$47.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.33 / $150.46 / $247.19	Professional		$97.33	$150.46	$247.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.54 / $51.43 / $85.44	Professional	26	$33.54	$51.43	$85.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.43 / $101.14 / $168.16	Professional	TC	$60.43	$101.14	$168.16
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $90.95 / $197.09 / $263.41	Professional		$90.95	$197.09	$263.41
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.09 / $60.55 / $85.80	Professional	26	$47.09	$60.55	$85.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.61 / $176.89 / $231.00	Professional	TC	$136.61	$176.89	$231.00
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.18 / $50.18 / $50.18	Professional	26	$50.18	$50.18	$50.18
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $39.76 / $39.76 / $39.76	Facility	26	$39.76	$39.76	$39.76
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $116.63 / $163.71 / $299.87	Professional		$116.63	$163.71	$299.87
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $38.68 / $50.01 / $119.09	Professional	26	$38.68	$50.01	$119.09
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $72.22 / $107.16 / $237.77	Professional	TC	$72.22	$107.16	$237.77
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $78.50 / $163.84 / $302.06	Professional		$78.50	$163.84	$302.06
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.89 / $47.14 / $47.14	Facility	26	$44.89	$47.14	$47.14
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $100.99 / $150.46 / $253.36	Professional		$100.99	$150.46	$253.36
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.32 / $51.43 / $90.48	Professional	26	$33.32	$51.43	$90.48
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.43 / $101.40 / $178.10	Professional	TC	$60.43	$101.40	$178.10
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $40.90 / $40.90 / $55.47	Facility	26	$40.90	$40.90	$55.47
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $128.74 / $131.00 / $141.93	Professional		$128.74	$131.00	$141.93
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $40.15 / $40.90 / $55.47	Professional	26	$40.15	$40.90	$55.47
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $79.53 / $90.10 / $99.18	Professional	TC	$79.53	$90.10	$99.18
United Facility/Professional Professional Modifier Low / Median / High Price $95.76 / $123.72 / $212.36	Professional		$95.76	$123.72	$212.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.63 / $49.11 / $81.95	Professional	26	$39.63	$49.11	$81.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.83 / $73.25 / $136.29	Professional	TC	$57.83	$73.25	$136.29