Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $38.90 / $104.71	Facility	26	$15.85	$38.90	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $52.48 / $102.33	Professional		$41.69	$52.48	$102.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.14 / $25.70	Professional	26	$12.02	$15.14	$25.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $34.67 / $54.95	Professional	TC	$28.84	$34.67	$54.95
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $41.69 / $87.10	Professional		$35.48	$41.69	$87.10
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $14.45 / $26.92	Professional	26	$12.30	$14.45	$26.92
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $27.54 / $60.26	Professional	TC	$23.44	$27.54	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $66.07 / $107.15	Professional		$41.69	$66.07	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.05 / $32.36	Professional	26	$13.80	$19.05	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $45.71 / $77.62	Professional	TC	$27.54	$45.71	$77.62
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $61.66 / $81.28	Professional		$47.86	$61.66	$81.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.95 / $26.30	Professional	26	$15.49	$19.95	$26.30
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $41.69 / $54.95	Professional	TC	$31.62	$41.69	$54.95
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $60.26 / $107.15	Professional		$39.81	$60.26	$107.15
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.20 / $33.11	Professional	26	$13.80	$18.20	$33.11
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $41.69 / $75.86	Professional	TC	$25.70	$41.69	$75.86
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $15.85 / $23.99 / $104.71	Facility	26	$15.85	$23.99	$104.71
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $147.91	Professional		$42.66	$57.54	$147.91
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.98 / $41.69	Professional	26	$12.88	$16.98	$41.69
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $104.71	Professional	TC	$28.84	$38.90	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $89.13 / $128.82	Professional		$69.18	$89.13	$128.82
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $14.13 / $18.20	Facility	26	$14.13	$14.13	$18.20
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $25.70 / $51.29	Professional		$8.71	$25.70	$51.29
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $14.13 / $14.45	Professional	26	$13.80	$14.13	$14.45
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $30.20 / $32.36	Professional	TC	$28.84	$30.20	$32.36
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $57.54 / $97.72	Professional		$41.69	$57.54	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $28.84	Professional	26	$13.18	$16.98	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $40.74 / $69.18	Professional	TC	$29.51	$40.74	$69.18