Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.26 / $103.09 / $181.22	Facility	26	$83.26	$103.09	$181.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.27 / $381.56 / $1,199.43	Professional		$238.27	$381.56	$1,199.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.47 / $91.53 / $241.38	Professional	26	$75.47	$91.53	$241.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.21 / $224.76 / $509.48	Professional	TC	$159.21	$224.76	$509.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.33 / $209.03 / $266.52	Professional		$173.33	$209.03	$266.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.65 / $91.98 / $136.08	Professional	26	$63.65	$91.98	$136.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.63 / $272.31 / $272.31	Professional	TC	$162.63	$272.31	$272.31
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $91.02 / $111.89 / $908.64	Professional	26	$91.02	$111.89	$908.64
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $257.70 / $349.80 / $1,088.93	Professional		$257.70	$349.80	$1,088.93
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $82.56 / $134.79 / $203.19	Professional	26	$82.56	$134.79	$203.19
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $175.13 / $245.29 / $885.70	Professional	TC	$175.13	$245.29	$885.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.60 / $501.29 / $926.14	Professional		$256.60	$501.29	$926.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.96 / $101.00 / $164.88	Professional	26	$59.96	$101.00	$164.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.71 / $360.75 / $794.34	Professional	TC	$178.71	$360.75	$794.34
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $310.54 / $411.95 / $1,433.08	Professional		$310.54	$411.95	$1,433.08
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.35 / $108.48 / $171.25	Professional	26	$90.35	$108.48	$171.25
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $209.61 / $260.94 / $371.65	Professional	TC	$209.61	$260.94	$371.65
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $318.45 / $319.82 / $351.81	Professional		$318.45	$319.82	$351.81
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.90 / $99.95 / $145.77	Professional	26	$91.90	$99.95	$145.77
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $353.16 / $353.44 / $353.44	Professional	TC	$353.16	$353.44	$353.44
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $106.30 / $676.84	Professional	26	$85.00	$106.30	$676.84
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $79.30 / $114.98 / $271.83	Facility	26	$79.30	$114.98	$271.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $241.94 / $367.09 / $1,138.55	Professional		$241.94	$367.09	$1,138.55
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $77.63 / $99.13 / $236.81	Professional	26	$77.63	$99.13	$236.81
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $162.63 / $234.61 / $604.57	Professional	TC	$162.63	$234.61	$604.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.27 / $230.64 / $426.62	Professional		$85.27	$230.64	$426.62
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.34 / $94.56 / $94.56	Facility	26	$57.34	$94.56	$94.56
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $267.24 / $472.17 / $915.81	Professional		$267.24	$472.17	$915.81
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $99.57 / $169.00	Professional	26	$62.72	$99.57	$169.00
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.65 / $360.75 / $731.66	Professional	TC	$187.65	$360.75	$731.66
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $82.29 / $82.29 / $91.08	Facility	26	$82.29	$82.29	$91.08
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $246.94 / $251.46 / $470.00	Professional		$246.94	$251.46	$470.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $80.14 / $82.38 / $91.08	Professional	26	$80.14	$82.38	$91.08
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $164.57 / $171.32 / $378.92	Professional	TC	$164.57	$171.32	$378.92
United Facility/Professional Professional Modifier Low / Median / High Price $257.79 / $380.02 / $663.48	Professional		$257.79	$380.02	$663.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.70 / $97.86 / $164.65	Professional	26	$77.70	$97.86	$164.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.66 / $258.06 / $548.04	Professional	TC	$178.66	$258.06	$548.04