Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.78 / $93.31 / $121.44	Facility	26	$81.78	$93.31	$121.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.50 / $296.70 / $1,082.00	Professional		$216.50	$296.70	$1,082.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.69 / $102.76 / $265.60	Professional	26	$76.69	$102.76	$265.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.61 / $170.00 / $279.43	Professional	TC	$138.61	$170.00	$279.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $216.73 / $233.06 / $384.55	Professional		$216.73	$233.06	$384.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $78.98 / $117.44 / $153.38	Professional	26	$78.98	$117.44	$153.38
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $233.06 / $311.11 / $524.26	Professional		$233.06	$311.11	$524.26
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $101.12 / $105.21 / $295.77	Professional	26	$101.12	$105.21	$295.77
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $223.05 / $308.25 / $483.32	Professional		$223.05	$308.25	$483.32
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $81.29 / $115.96 / $158.07	Professional	26	$81.29	$115.96	$158.07
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $141.75 / $192.30 / $325.25	Professional	TC	$141.75	$192.30	$325.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.98 / $323.70 / $517.40	Professional		$230.98	$323.70	$517.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.75 / $114.96 / $180.29	Professional	26	$80.75	$114.96	$180.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $152.07 / $195.83 / $321.05	Professional	TC	$152.07	$195.83	$321.05
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $283.22 / $348.39 / $716.46	Professional		$283.22	$348.39	$716.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.16 / $117.00 / $239.59	Professional	26	$97.16	$117.00	$239.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.45 / $231.39 / $476.87	Professional	TC	$184.45	$231.39	$476.87
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $295.77 / $311.11 / $505.31	Professional		$295.77	$311.11	$505.31
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $101.12 / $105.21 / $172.79	Professional	26	$101.12	$105.21	$172.79
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $81.78 / $101.25 / $141.87	Facility	26	$81.78	$101.25	$141.87
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $224.13 / $326.37 / $1,013.00	Professional		$224.13	$326.37	$1,013.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $77.89 / $119.52 / $265.25	Professional	26	$77.89	$119.52	$265.25
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $138.61 / $190.69 / $458.95	Professional	TC	$138.61	$190.69	$458.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $131.12 / $321.80 / $484.48	Professional		$131.12	$321.80	$484.48
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $230.20 / $318.45 / $525.63	Professional		$230.20	$318.45	$525.63
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.53 / $114.26 / $189.42	Professional	26	$80.53	$114.26	$189.42
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.24 / $193.71 / $320.39	Professional	TC	$148.24	$193.71	$320.39
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $80.43 / $80.43 / $105.00	Facility	26	$80.43	$80.43	$105.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $219.90 / $222.99 / $263.00	Professional		$219.90	$222.99	$263.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $78.53 / $80.43 / $105.00	Professional	26	$78.53	$80.43	$105.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $139.59 / $142.55 / $158.00	Professional	TC	$139.59	$142.55	$158.00
United Facility/Professional Professional Modifier Low / Median / High Price $228.25 / $289.88 / $475.47	Professional		$228.25	$289.88	$475.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.98 / $109.31 / $169.52	Professional	26	$81.98	$109.31	$169.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.38 / $180.84 / $287.25	Professional	TC	$142.38	$180.84	$287.25