Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $61.66 / $316.23	Facility	26	$40.74	$61.66	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $158.49 / $676.08	Professional		$128.82	$158.49	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $158.49	Professional	26	$40.74	$51.29	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $107.15 / $223.87	Professional	TC	$85.11	$107.15	$223.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $100.00 / $107.15	Professional		$85.11	$100.00	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $33.11 / $63.10	Professional	26	$31.62	$33.11	$63.10
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $134.90	Professional		$114.82	$131.83	$134.90
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $44.67 / $93.33	Professional	26	$42.66	$44.67	$93.33
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $91.20 / $194.98	Professional	TC	$87.10	$91.20	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $316.23	Professional		$131.83	$199.53	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $57.54 / $95.50	Professional	26	$42.66	$57.54	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $144.54 / $223.87	Professional	TC	$89.13	$144.54	$223.87
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $190.55 / $213.80	Professional		$162.18	$190.55	$213.80
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $57.54 / $69.18	Professional	26	$50.12	$57.54	$69.18
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $131.83 / $162.18	Professional	TC	$114.82	$131.83	$162.18
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $194.98 / $281.84	Professional		$141.25	$194.98	$281.84
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $89.13	Professional	26	$43.65	$57.54	$89.13
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $194.98	Professional	TC	$95.50	$138.04	$194.98
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $57.54 / $316.23	Facility	26	$40.74	$57.54	$316.23
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $194.98 / $389.05	Professional		$128.82	$194.98	$389.05
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $61.66 / $123.03	Professional	26	$40.74	$61.66	$123.03
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $131.83 / $263.03	Professional	TC	$87.10	$131.83	$263.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $251.19 / $295.12	Professional		$93.33	$251.19	$295.12
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $128.82 / $338.84	Professional		$100.00	$128.82	$338.84
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $51.29	Professional	26	$41.69	$51.29	$51.29
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $134.90 / $134.90	Professional	TC	$89.13	$134.90	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $275.42	Professional		$128.82	$177.83	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $87.10	Professional	26	$40.74	$53.70	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $120.23 / $194.98	Professional	TC	$85.11	$120.23	$194.98