Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $81.70 / $143.66	Facility	26	$65.98	$81.70	$143.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.13 / $287.80 / $1,141.50	Professional		$180.13	$287.80	$1,141.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.43 / $91.46 / $254.79	Professional	26	$61.43	$91.46	$254.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $185.04 / $438.09	Professional	TC	$114.82	$185.04	$438.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.51 / $139.44 / $161.30	Professional		$125.51	$139.44	$161.30
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.39 / $67.56 / $107.28	Professional	26	$49.39	$67.56	$107.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $121.15 / $159.12 / $180.87	Professional	TC	$121.15	$159.12	$180.87
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $75.56 / $87.66 / $1,325.87	Professional	26	$75.56	$87.66	$1,325.87
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $181.44 / $302.26 / $632.88	Professional		$181.44	$302.26	$632.88
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $65.12 / $106.53 / $159.74	Professional	26	$65.12	$106.53	$159.74
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $116.32 / $195.72 / $473.07	Professional	TC	$116.32	$195.72	$473.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.17 / $311.25 / $518.66	Professional		$171.17	$311.25	$518.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.56 / $79.68 / $130.05	Professional	26	$47.56	$79.68	$130.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.47 / $217.48 / $387.02	Professional	TC	$114.47	$217.48	$387.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $217.89 / $288.64 / $755.00	Professional		$217.89	$288.64	$755.00
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.23 / $85.56 / $135.10	Professional	26	$71.23	$85.56	$135.10
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.22 / $173.33 / $246.86	Professional	TC	$139.22	$173.33	$246.86
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $212.68 / $233.99 / $395.21	Professional		$212.68	$233.99	$395.21
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.77 / $80.56 / $113.53	Professional	26	$72.77	$80.56	$113.53
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.89 / $216.88 / $218.26	Professional	TC	$181.89	$216.88	$218.26
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $68.45 / $83.18 / $610.29	Professional	26	$68.45	$83.18	$610.29
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $62.85 / $91.13 / $215.50	Facility	26	$62.85	$91.13	$215.50
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $180.14 / $278.64 / $916.00	Professional		$180.14	$278.64	$916.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $61.79 / $92.51 / $210.00	Professional	26	$61.79	$92.51	$210.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $117.29 / $168.39 / $435.78	Professional	TC	$117.29	$168.39	$435.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.33 / $188.26 / $367.30	Professional		$74.33	$188.26	$367.30
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $45.13 / $74.84 / $74.84	Facility	26	$45.13	$74.84	$74.84
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $176.54 / $304.42 / $511.19	Professional		$176.54	$304.42	$511.19
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.70 / $79.30 / $133.54	Professional	26	$49.70	$79.30	$133.54
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.23 / $208.46 / $380.10	Professional	TC	$115.23	$208.46	$380.10
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $65.04 / $65.04 / $75.00	Facility	26	$65.04	$65.04	$75.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $184.53 / $369.00	Professional		$181.97	$184.53	$369.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.39 / $65.05 / $75.00	Professional	26	$63.39	$65.05	$75.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $116.92 / $119.49 / $294.00	Professional	TC	$116.92	$119.49	$294.00
United Facility/Professional Professional Modifier Low / Median / High Price $176.36 / $244.94 / $392.46	Professional		$176.36	$244.94	$392.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.44 / $77.03 / $130.10	Professional	26	$60.44	$77.03	$130.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $113.83 / $164.23 / $298.08	Professional	TC	$113.83	$164.23	$298.08