Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.26 / $62.46 / $161.77	Facility	26	$61.26	$62.46	$161.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $367.80 / $415.39 / $613.11	Professional		$367.80	$415.39	$613.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.40 / $61.26 / $83.37	Professional	26	$53.40	$61.26	$83.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $179.03 / $203.80 / $281.98	Professional	52	$179.03	$203.80	$281.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $315.51 / $351.36 / $540.64	Professional	TC	$315.51	$351.36	$540.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.94 / $83.94 / $83.94	Professional	26	$83.94	$83.94	$83.94
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $397.96 / $412.97 / $801.12	Professional		$397.96	$412.97	$801.12
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $58.18 / $60.38 / $113.55	Professional	26	$58.18	$60.38	$113.55
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $339.76 / $352.58 / $687.61	Professional	TC	$339.76	$352.58	$687.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $378.62 / $581.14 / $917.17	Professional		$378.62	$581.14	$917.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.59 / $83.53 / $136.32	Professional	26	$56.59	$83.53	$136.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $322.39 / $495.58 / $782.04	Professional	TC	$322.39	$495.58	$782.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $432.16 / $630.16 / $829.46	Professional		$432.16	$630.16	$829.46
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $83.30 / $113.28	Professional	26	$56.23	$83.30	$113.28
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $375.93 / $546.87 / $710.26	Professional	TC	$375.93	$546.87	$710.26
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $61.26 / $82.70 / $161.77	Facility	26	$61.26	$82.70	$161.77
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $367.80 / $461.05 / $757.32	Professional		$367.80	$461.05	$757.32
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $53.94 / $64.17 / $97.60	Professional	26	$53.94	$64.17	$97.60
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $179.03 / $206.91 / $344.93	Professional	52	$179.03	$206.91	$344.93
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $315.51 / $384.22 / $642.99	Professional	TC	$315.51	$384.22	$642.99
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.42 / $565.29 / $808.70	Professional		$62.42	$565.29	$808.70
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $67.31 / $67.31 / $67.31	Facility	26	$67.31	$67.31	$67.31
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $378.62 / $573.74 / $918.35	Professional		$378.62	$573.74	$918.35
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.97 / $83.00 / $143.41	Professional	26	$55.97	$83.00	$143.41
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $322.20 / $489.39 / $792.50	Professional	TC	$322.20	$489.39	$792.50
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $57.57 / $57.57 / $89.50	Facility	26	$57.57	$57.57	$89.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $361.49 / $367.95 / $401.25	Professional		$361.49	$367.95	$401.25
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $56.20 / $57.57 / $59.51	Professional	26	$56.20	$57.57	$59.51
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $304.00 / $310.39 / $341.74	Professional	TC	$304.00	$310.39	$341.74
United Facility/Professional Professional Modifier Low / Median / High Price $374.76 / $489.46 / $826.49	Professional		$374.76	$489.46	$826.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.42 / $74.56 / $116.35	Professional	26	$55.42	$74.56	$116.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $312.97 / $411.80 / $676.35	Professional	TC	$312.97	$411.80	$676.35