Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.81 / $106.79 / $106.79	Facility	26	$95.81	$106.79	$106.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.07 / $284.98 / $456.65	Professional		$242.07	$284.98	$456.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.56 / $99.27 / $145.08	Professional	26	$90.56	$99.27	$145.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.69 / $188.48 / $330.97	Professional	TC	$146.69	$188.48	$330.97
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $253.32 / $298.02 / $506.83	Professional		$253.32	$298.02	$506.83
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $99.67 / $145.27 / $247.72	Professional	26	$99.67	$145.27	$247.72
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $109.54 / $188.99 / $321.68	Professional	TC	$109.54	$188.99	$321.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.59 / $114.59 / $114.59	Facility	26	$114.59	$114.59	$114.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.92 / $343.83 / $616.74	Professional		$203.92	$343.83	$616.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.03 / $127.27 / $220.91	Professional	26	$94.03	$127.27	$220.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.46 / $216.70 / $434.01	Professional	TC	$122.46	$216.70	$434.01
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $298.77 / $437.10 / $585.60	Professional		$298.77	$437.10	$585.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.77 / $144.49 / $195.97	Professional	26	$97.77	$144.49	$195.97
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $201.00 / $292.61 / $381.07	Professional	TC	$201.00	$292.61	$381.07
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $106.79 / $106.79 / $106.79	Facility	26	$106.79	$106.79	$106.79
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $242.28 / $330.29 / $541.51	Professional		$242.28	$330.29	$541.51
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $92.15 / $104.21 / $181.78	Professional	26	$92.15	$104.21	$181.78
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $148.65 / $226.11 / $446.72	Professional	TC	$148.65	$226.11	$446.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $118.67 / $248.10 / $476.54	Professional		$118.67	$248.10	$476.54
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $110.62 / $114.59 / $114.59	Facility	26	$110.62	$114.59	$114.59
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $214.51 / $346.46 / $663.24	Professional		$214.51	$346.46	$663.24
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.49 / $128.44 / $232.97	Professional	26	$95.49	$128.44	$232.97
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.04 / $223.20 / $460.69	Professional	TC	$120.04	$223.20	$460.69
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $98.32 / $98.32 / $107.00	Facility	26	$98.32	$98.32	$107.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $260.56 / $264.27 / $284.98	Professional		$260.56	$264.27	$284.98
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $96.06 / $98.32 / $102.28	Professional	26	$96.06	$98.32	$102.28
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $162.46 / $165.95 / $182.70	Professional	TC	$162.46	$165.95	$182.70
United Facility/Professional Professional Modifier Low / Median / High Price $207.27 / $286.83 / $492.46	Professional		$207.27	$286.83	$492.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.48 / $119.60 / $193.78	Professional	26	$90.48	$119.60	$193.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.68 / $178.35 / $314.41	Professional	TC	$126.68	$178.35	$314.41