Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.28 / $26.57 / $89.28	Facility	26	$24.28	$26.57	$89.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.65 / $123.15 / $187.44	Professional		$101.65	$123.15	$187.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.79 / $31.18 / $78.91	Professional	26	$22.79	$31.18	$78.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.04 / $99.37 / $151.91	Professional	TC	$69.04	$99.37	$151.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.46 / $51.59 / $62.61	Professional	26	$27.46	$51.59	$62.61
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $140.09 / $145.38 / $263.17	Professional		$140.09	$145.38	$263.17
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $36.86 / $47.84	Professional	26	$32.86	$36.86	$47.84
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $104.57 / $108.52 / $215.34	Professional	TC	$104.57	$108.52	$215.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $39.43	Facility	26	$39.43	$39.43	$39.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.37 / $217.40 / $357.65	Professional		$145.37	$217.40	$357.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.41 / $36.86 / $55.80	Professional	26	$25.41	$36.86	$55.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.52 / $186.44 / $302.39	Professional	TC	$121.52	$186.44	$302.39
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $179.94 / $226.17 / $457.69	Professional		$179.94	$226.17	$457.69
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.76 / $52.64 / $106.53	Professional	26	$42.76	$52.64	$106.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.15 / $173.53 / $351.16	Professional	TC	$136.15	$173.53	$351.16
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $26.57 / $82.63 / $99.11	Facility	26	$26.57	$82.63	$99.11
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $101.65 / $125.74 / $314.14	Professional		$101.65	$125.74	$314.14
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $35.50 / $80.95	Professional	26	$23.52	$35.50	$80.95
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $69.04 / $100.25 / $255.83	Professional	TC	$69.04	$100.25	$255.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $51.95 / $179.20 / $307.20	Professional		$51.95	$179.20	$307.20
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.43 / $39.43 / $39.43	Facility	26	$39.43	$39.43	$39.43
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $144.55 / $217.30 / $357.65	Professional		$144.55	$217.30	$357.65
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.64 / $36.86 / $56.83	Professional	26	$25.64	$36.86	$56.83
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.52 / $186.44 / $309.20	Professional	TC	$121.52	$186.44	$309.20
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $24.50 / $24.50 / $40.50	Facility	26	$24.50	$24.50	$40.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $122.33 / $125.64 / $185.00	Professional		$122.33	$125.64	$185.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $23.81 / $24.57 / $40.50	Professional	26	$23.81	$24.57	$40.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.76 / $101.84 / $144.50	Professional	TC	$97.76	$101.84	$144.50
United Facility/Professional Professional Modifier Low / Median / High Price $140.47 / $187.69 / $319.79	Professional		$140.47	$187.69	$319.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $33.18 / $54.55	Professional	26	$25.00	$33.18	$54.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $118.69 / $163.19 / $279.22	Professional	TC	$118.69	$163.19	$279.22