Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.17 / $69.17 / $107.85	Facility	26	$69.17	$69.17	$107.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.52 / $264.55 / $948.06	Professional		$206.52	$264.55	$948.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.51 / $84.05 / $277.00	Professional	26	$56.51	$84.05	$277.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.28 / $166.12 / $291.83	Professional	TC	$146.28	$166.12	$291.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.83 / $207.83 / $207.83	Professional		$207.83	$207.83	$207.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.35 / $92.84 / $99.41	Professional	26	$46.35	$92.84	$99.41
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $71.58 / $78.01 / $82.29	Professional	26	$71.58	$78.01	$82.29
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $208.26 / $346.00 / $477.75	Professional		$208.26	$346.00	$477.75
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $60.46 / $98.00 / $152.53	Professional	26	$60.46	$98.00	$152.53
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $147.80 / $248.01 / $324.19	Professional	TC	$147.80	$248.01	$324.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $215.33 / $283.19 / $452.04	Professional		$215.33	$283.19	$452.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.38 / $82.15 / $133.63	Professional	26	$59.38	$82.15	$133.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $149.74 / $202.17 / $320.98	Professional	TC	$149.74	$202.17	$320.98
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $266.20 / $333.48 / $674.83	Professional		$266.20	$333.48	$674.83
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.29 / $88.16 / $178.40	Professional	26	$72.29	$88.16	$178.40
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $192.42 / $245.32 / $496.43	Professional	TC	$192.42	$245.32	$496.43
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $75.23 / $78.27 / $128.54	Professional	26	$75.23	$78.27	$128.54
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $57.80 / $86.13 / $439.23	Facility	26	$57.80	$86.13	$439.23
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $210.93 / $378.87 / $920.39	Professional		$210.93	$378.87	$920.39
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $58.65 / $108.80 / $263.19	Professional	26	$58.65	$108.80	$263.19
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $148.71 / $183.73 / $468.84	Professional	TC	$148.71	$183.73	$468.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $98.33 / $273.89 / $419.40	Professional		$98.33	$273.89	$419.40
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $207.58 / $280.35 / $436.54	Professional		$207.58	$280.35	$436.54
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.38 / $81.19 / $140.88	Professional	26	$59.38	$81.19	$140.88
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.16 / $201.82 / $319.85	Professional	TC	$149.16	$201.82	$319.85
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $59.83 / $59.83 / $78.76	Facility	26	$59.83	$59.83	$78.76
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $207.95 / $211.23 / $254.43	Professional		$207.95	$211.23	$254.43
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $58.44 / $59.83 / $78.76	Professional	26	$58.44	$59.83	$78.76
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $148.24 / $151.41 / $175.67	Professional	TC	$148.24	$151.41	$175.67
United Facility/Professional Professional Modifier Low / Median / High Price $216.12 / $270.62 / $428.14	Professional		$216.12	$270.62	$428.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.37 / $80.95 / $127.91	Professional	26	$61.37	$80.95	$127.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.91 / $203.98 / $319.79	Professional	TC	$150.91	$203.98	$319.79