Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.28 / $50.90 / $141.60	Facility	26	$40.28	$50.90	$141.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.57 / $178.59 / $665.77	Professional		$102.57	$178.59	$665.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.10 / $44.13 / $118.01	Professional	26	$36.10	$44.13	$118.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.18 / $128.80 / $414.16	Professional	TC	$64.18	$128.80	$414.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $81.06 / $93.81	Professional		$72.95	$81.06	$93.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.52 / $43.37 / $66.40	Professional	26	$30.52	$43.37	$66.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.88 / $101.30 / $101.30	Professional	TC	$67.88	$101.30	$101.30
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $46.73 / $54.58 / $376.87	Professional	26	$46.73	$54.58	$376.87
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $105.43 / $176.41 / $493.25	Professional		$105.43	$176.41	$493.25
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $40.27 / $65.23 / $99.26	Professional	26	$40.27	$65.23	$99.26
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $65.16 / $109.58 / $394.00	Professional	TC	$65.16	$109.58	$394.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.39 / $198.77 / $352.71	Professional		$92.39	$198.77	$352.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $49.33 / $80.06	Professional	26	$29.01	$49.33	$80.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.49 / $126.19 / $257.80	Professional	TC	$57.49	$126.19	$257.80
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $126.37 / $167.34 / $523.36	Professional		$126.37	$167.34	$523.36
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.08 / $52.93 / $83.51	Professional	26	$44.08	$52.93	$83.51
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.98 / $97.09 / $138.29	Professional	TC	$77.98	$97.09	$138.29
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $77.40 / $77.40 / $77.40	Facility	26	$77.40	$77.40	$77.40
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.28 / $130.84 / $142.59	Professional		$122.28	$130.84	$142.59
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.11 / $50.50 / $75.00	Professional	26	$45.11	$50.50	$75.00
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.95 / $121.48 / $196.26	Professional	TC	$100.95	$121.48	$196.26
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.34 / $53.00 / $376.87	Professional	26	$42.34	$53.00	$376.87
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $38.36 / $55.63 / $144.69	Facility	26	$38.36	$55.63	$144.69
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $102.57 / $155.16 / $648.41	Professional		$102.57	$155.16	$648.41
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $36.46 / $46.04 / $113.23	Professional	26	$36.46	$46.04	$113.23
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $64.19 / $92.81 / $265.00	Professional	TC	$64.19	$92.81	$265.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.82 / $103.39 / $325.00	Professional		$41.82	$103.39	$325.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.97 / $45.92 / $45.92	Facility	26	$27.97	$45.92	$45.92
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $99.46 / $192.74 / $334.79	Professional		$99.46	$192.74	$334.79
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.21 / $49.04 / $82.45	Professional	26	$30.21	$49.04	$82.45
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.47 / $126.13 / $251.62	Professional	TC	$61.47	$126.13	$251.62
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.83 / $39.83 / $45.50	Facility	26	$39.83	$39.83	$45.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $104.47 / $105.90 / $226.50	Professional		$104.47	$105.90	$226.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.84 / $39.83 / $45.50	Professional	26	$38.84	$39.83	$45.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $64.64 / $66.06 / $181.00	Professional	TC	$64.64	$66.06	$181.00
United Facility/Professional Professional Modifier Low / Median / High Price $100.69 / $147.65 / $256.74	Professional		$100.69	$147.65	$256.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.32 / $47.53 / $79.15	Professional	26	$37.32	$47.53	$79.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.09 / $91.80 / $195.85	Professional	TC	$62.09	$91.80	$195.85