Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.61 / $56.81 / $108.37	Facility	26	$40.61	$56.81	$108.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $253.19 / $805.77	Professional		$123.87	$253.19	$805.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.86 / $55.97 / $160.62	Professional	26	$37.86	$55.97	$160.62
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.63 / $70.09 / $137.50	Professional	52	$60.63	$70.09	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.55 / $168.00 / $308.42	Professional	TC	$84.55	$168.00	$308.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.76 / $96.87 / $123.49	Professional		$84.76	$96.87	$123.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.75 / $44.86 / $66.95	Professional	26	$30.75	$44.86	$66.95
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $116.96 / $132.91 / $132.91	Professional	TC	$116.96	$132.91	$132.91
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $47.10 / $54.58 / $642.48	Professional	26	$47.10	$54.58	$642.48
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $137.97 / $212.48 / $525.86	Professional		$137.97	$212.48	$525.86
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $67.97 / $131.86	Professional	26	$44.42	$67.97	$131.86
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $93.57 / $144.15 / $394.00	Professional	TC	$93.57	$144.15	$394.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $118.95 / $240.44 / $419.46	Professional		$118.95	$240.44	$419.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $57.99 / $94.56	Professional	26	$33.77	$57.99	$94.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.66 / $164.54 / $318.47	Professional	TC	$80.66	$164.54	$318.47
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $151.94 / $201.50 / $631.44	Professional		$151.94	$201.50	$631.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.46 / $53.40 / $84.17	Professional	26	$44.46	$53.40	$84.17
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.31 / $127.41 / $181.50	Professional	TC	$102.31	$127.41	$181.50
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $139.71 / $152.30 / $278.43	Professional		$139.71	$152.30	$278.43
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.01 / $51.59 / $75.55	Professional	26	$45.01	$51.59	$75.55
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $133.62 / $159.40 / $160.34	Professional	TC	$133.62	$159.40	$160.34
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $132.24 / $132.24 / $132.24	Professional		$132.24	$132.24	$132.24
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $45.45 / $51.78 / $101.01	Professional	26	$45.45	$51.78	$101.01
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $40.61 / $56.09 / $141.06	Facility	26	$40.61	$56.09	$141.06
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $233.14 / $730.29	Professional		$123.87	$233.14	$730.29
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $38.15 / $56.55 / $145.00	Professional	26	$38.15	$56.55	$145.00
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $60.63 / $75.62 / $169.27	Professional	52	$60.63	$75.62	$169.27
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $85.19 / $131.69 / $316.57	Professional	TC	$85.19	$131.69	$316.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $46.33 / $120.82 / $325.00	Professional		$46.33	$120.82	$325.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $37.25 / $46.27 / $46.27	Facility	26	$37.25	$46.27	$46.27
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $124.40 / $235.00 / $409.55	Professional		$124.40	$235.00	$409.55
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.49 / $57.96 / $96.61	Professional	26	$34.49	$57.96	$96.61
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.86 / $164.50 / $316.54	Professional	TC	$83.86	$164.50	$316.54
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $40.15 / $40.15 / $66.00	Facility	26	$40.15	$40.15	$66.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $125.79 / $127.72 / $264.50	Professional		$125.79	$127.72	$264.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.15 / $40.15 / $66.00	Professional	26	$39.15	$40.15	$66.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $85.66 / $87.57 / $198.50	Professional	TC	$85.66	$87.57	$198.50
United Facility/Professional Professional Modifier Low / Median / High Price $121.09 / $174.90 / $311.45	Professional		$121.09	$174.90	$311.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.37 / $83.16	Professional	26	$38.90	$51.37	$83.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.18 / $113.22 / $218.88	Professional	TC	$82.18	$113.22	$218.88