Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $49.36 / $246.31	Facility	26	$41.16	$49.36	$246.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.71 / $151.71 / $286.17	Professional		$125.71	$151.71	$286.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $49.24 / $100.53	Professional	26	$40.11	$49.24	$100.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.54 / $106.59 / $180.06	Professional	TC	$85.54	$106.59	$180.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.62 / $100.62 / $100.62	Professional		$100.62	$100.62	$100.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $32.97 / $32.97	Professional	26	$32.97	$32.97	$32.97
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $115.57 / $135.97 / $232.86	Professional		$115.57	$135.97	$232.86
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.98 / $69.65 / $107.82	Professional	26	$42.98	$69.65	$107.82
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $88.04 / $130.93 / $275.56	Professional	TC	$88.04	$130.93	$275.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $132.82 / $199.98 / $320.89	Professional		$132.82	$199.98	$320.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.58 / $58.87 / $95.37	Professional	26	$42.58	$58.87	$95.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.84 / $143.44 / $219.69	Professional	TC	$87.84	$143.44	$219.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $135.00 / $192.50 / $422.89	Professional		$135.00	$192.50	$422.89
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.43 / $61.90 / $127.03	Professional	26	$51.43	$61.90	$127.03
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.60 / $143.74 / $295.87	Professional	TC	$114.60	$143.74	$295.87
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.66 / $54.65 / $54.65	Professional	26	$51.66	$54.65	$54.65
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $41.16 / $55.57 / $313.44	Facility	26	$41.16	$55.57	$313.44
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $128.49 / $179.21 / $540.62	Professional		$128.49	$179.21	$540.62
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $41.16 / $61.23 / $121.23	Professional	26	$41.16	$61.23	$121.23
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $87.33 / $117.26 / $252.41	Professional	TC	$87.33	$117.26	$252.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.95 / $208.59 / $309.00	Professional		$69.95	$208.59	$309.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $130.38 / $192.92 / $315.29	Professional		$130.38	$192.92	$315.29
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.58 / $57.83 / $99.41	Professional	26	$42.58	$57.83	$99.41
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.21 / $136.91 / $219.69	Professional	TC	$87.21	$136.91	$219.69
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.52 / $42.52 / $51.14	Facility	26	$42.52	$42.52	$51.14
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $129.44 / $131.35 / $187.19	Professional		$129.44	$131.35	$187.19
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.47 / $42.52 / $51.14	Professional	26	$41.47	$42.52	$51.14
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $86.95 / $88.82 / $136.05	Professional	TC	$86.95	$88.82	$136.05
United Facility/Professional Professional Modifier Low / Median / High Price $137.06 / $192.33 / $288.60	Professional		$137.06	$192.33	$288.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.36 / $57.66 / $90.37	Professional	26	$43.36	$57.66	$90.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.21 / $122.97 / $197.83	Professional	TC	$89.21	$122.97	$197.83