Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.77 / $62.06 / $208.52	Facility	26	$56.77	$62.06	$208.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.65 / $164.39 / $296.56	Professional		$138.65	$164.39	$296.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.62 / $58.60 / $90.03	Professional	26	$52.62	$58.60	$90.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.91 / $109.01 / $190.10	Professional	TC	$88.91	$109.01	$190.10
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $162.43 / $227.13 / $596.64	Professional		$162.43	$227.13	$596.64
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $57.87 / $93.78 / $140.91	Professional	26	$57.87	$93.78	$140.91
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $104.57 / $144.38 / $482.80	Professional	TC	$104.57	$144.38	$482.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.70 / $66.70 / $66.70	Facility	26	$66.70	$66.70	$66.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $278.95 / $368.01 / $611.85	Professional		$278.95	$368.01	$611.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.79 / $72.09 / $120.23	Professional	26	$54.79	$72.09	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.73 / $298.74 / $502.22	Professional	TC	$218.73	$298.74	$502.22
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $206.97 / $259.20 / $524.54	Professional		$206.97	$259.20	$524.54
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.78 / $85.68 / $173.39	Professional	26	$69.78	$85.68	$173.39
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 $62.06 / $193.01 / $231.48	Facility	26	$62.06	$193.01	$231.48
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $149.13 / $191.01 / $466.23	Professional		$149.13	$191.01	$466.23
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $53.46 / $62.06 / $152.32	Professional	26	$53.46	$62.06	$152.32
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $95.20 / $119.55 / $306.13	Professional	TC	$95.20	$119.55	$306.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $84.05 / $215.96 / $558.04	Professional		$84.05	$215.96	$558.04
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $66.70 / $66.70 / $66.70	Facility	26	$66.70	$66.70	$66.70
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $278.95 / $373.12 / $623.03	Professional		$278.95	$373.12	$623.03
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.79 / $72.23 / $126.27	Professional	26	$54.79	$72.23	$126.27
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.45 / $302.74 / $502.22	Professional	TC	$218.45	$302.74	$502.22
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.25 / $57.25 / $62.50	Facility	26	$57.25	$57.25	$62.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $154.96 / $157.69 / $242.50	Professional		$154.96	$157.69	$242.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $55.86 / $57.25 / $62.50	Professional	26	$55.86	$57.25	$62.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.76 / $101.84 / $180.00	Professional	TC	$97.76	$101.84	$180.00
United Facility/Professional Professional Modifier Low / Median / High Price $249.01 / $330.68 / $581.40	Professional		$249.01	$330.68	$581.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.79 / $67.77 / $115.24	Professional	26	$52.79	$67.77	$115.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.09 / $288.13 / $471.73	Professional	TC	$204.09	$288.13	$471.73