Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $120.23 / $218.78	Facility	26	$81.28	$120.23	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $346.74 / $1,096.48	Professional		$223.87	$346.74	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $125.89 / $363.08	Professional	26	$77.62	$125.89	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $371.54	Professional	TC	$138.04	$177.83	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $239.88 / $380.19	Professional		$208.93	$239.88	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $125.89 / $154.88	Professional	26	$79.43	$125.89	$154.88
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $416.87	Professional		$194.98	$229.09	$416.87
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $85.11 / $154.88	Professional	26	$72.44	$85.11	$154.88
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $257.04	Professional	TC	$125.89	$147.91	$257.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $323.59 / $512.86	Professional		$229.09	$323.59	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $112.20 / $177.83	Professional	26	$81.28	$112.20	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $323.59	Professional	TC	$151.36	$194.98	$323.59
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $398.11	Professional		$281.84	$323.59	$398.11
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $107.15 / $131.83	Professional	26	$93.33	$107.15	$131.83
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $208.93 / $263.03	Professional	TC	$181.97	$208.93	$263.03
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $302.00 / $478.63	Professional		$239.88	$302.00	$478.63
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $109.65 / $173.78	Professional	26	$83.18	$109.65	$173.78
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $181.97 / $302.00	Professional	TC	$147.91	$181.97	$302.00
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $120.23 / $204.17	Facility	26	$81.28	$120.23	$204.17
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $346.74 / $851.14	Professional		$229.09	$346.74	$851.14
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $120.23 / $263.03	Professional	26	$77.62	$120.23	$263.03
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $199.53 / $416.87	Professional	TC	$144.54	$199.53	$416.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $346.74 / $537.03	Professional		$162.18	$346.74	$537.03
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $104.71 / $104.71	Facility	26	$81.28	$104.71	$104.71
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $229.09 / $407.38	Professional		$91.20	$229.09	$407.38
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $81.28 / $104.71	Professional	26	$79.43	$81.28	$104.71
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $144.54 / $158.49	Professional	TC	$138.04	$144.54	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $281.84 / $436.52	Professional		$213.80	$281.84	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $104.71 / $165.96	Professional	26	$75.86	$104.71	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $281.84	Professional	TC	$138.04	$177.83	$281.84