Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.33 / $59.85 / $162.59	Facility	26	$44.33	$59.85	$162.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $251.42 / $436.57	Professional		$206.63	$251.42	$436.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.12 / $48.56 / $121.45	Professional	26	$41.12	$48.56	$121.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $208.00 / $366.55	Professional	TC	$162.49	$208.00	$366.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $189.16 / $189.16 / $189.16	Professional		$189.16	$189.16	$189.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $34.54 / $65.19	Professional	26	$33.34	$34.54	$65.19
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $246.35 / $340.00 / $501.05	Professional		$246.35	$340.00	$501.05
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $44.84 / $72.72 / $112.77	Professional	26	$44.84	$72.72	$112.77
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $193.80 / $279.64 / $412.70	Professional	TC	$193.80	$279.64	$412.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.82 / $356.73 / $594.16	Professional		$247.82	$356.73	$594.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.85 / $57.95 / $95.01	Professional	26	$42.85	$57.95	$95.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $205.63 / $300.98 / $508.77	Professional	TC	$205.63	$300.98	$508.77
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $318.35 / $400.50 / $810.46	Professional		$318.35	$400.50	$810.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.03 / $66.34 / $134.26	Professional	26	$54.03	$66.34	$134.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $262.45 / $334.14 / $676.18	Professional	TC	$262.45	$334.14	$676.18
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.05 / $56.12 / $61.26	Professional	26	$53.05	$56.12	$61.26
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $48.39 / $143.71 / $180.50	Facility	26	$48.39	$143.71	$180.50
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $258.27 / $613.71	Professional		$206.63	$258.27	$613.71
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $43.27 / $56.67 / $122.73	Professional	26	$43.27	$56.67	$122.73
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $226.68 / $481.16	Professional	TC	$162.49	$226.68	$481.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.23 / $268.70 / $583.90	Professional		$66.23	$268.70	$583.90
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $246.86 / $356.67 / $614.79	Professional		$246.86	$356.67	$614.79
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.85 / $57.95 / $100.10	Professional	26	$42.85	$57.95	$100.10
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $205.63 / $297.07 / $517.66	Professional	TC	$205.63	$297.07	$517.66
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $44.40 / $44.40 / $56.50	Facility	26	$44.40	$44.40	$56.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $253.15 / $257.77 / $290.50	Professional		$253.15	$257.77	$290.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.34 / $44.40 / $56.50	Professional	26	$43.34	$44.40	$56.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $208.81 / $213.38 / $234.91	Professional	TC	$208.81	$213.38	$234.91
United Facility/Professional Professional Modifier Low / Median / High Price $227.64 / $295.79 / $522.37	Professional		$227.64	$295.79	$522.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.51 / $54.43 / $92.48	Professional	26	$41.51	$54.43	$92.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.95 / $259.80 / $453.27	Professional	TC	$198.95	$259.80	$453.27