Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $138.04 / $416.87	Facility	26	$70.79	$138.04	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $416.87 / $1,445.44	Professional		$204.17	$416.87	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $107.15 / $275.42	Professional	26	$67.61	$107.15	$275.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $107.15 / $190.55 / $588.84	Professional	52	$107.15	$190.55	$588.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $257.04 / $741.31	Professional	TC	$131.83	$257.04	$741.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $288.40	Professional		$138.04	$169.82	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $114.82	Professional	26	$53.70	$66.07	$114.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $117.49 / $190.55	Professional	TC	$114.82	$117.49	$190.55
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $346.74 / $602.56	Professional		$213.80	$346.74	$602.56
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $93.33 / $173.78	Professional	26	$75.86	$93.33	$173.78
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $223.87 / $707.95	Professional	TC	$134.90	$223.87	$707.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $40.74 / $61.66	Facility	53	$22.91	$40.74	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $407.38 / $794.33	Professional		$190.55	$407.38	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $87.10 / $144.54	Professional	26	$52.48	$87.10	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $295.12 / $676.08	Professional	TC	$120.23	$295.12	$676.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $269.15 / $1,096.48	Professional		$204.17	$269.15	$1,096.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $91.20 / $109.65	Professional	26	$69.18	$91.20	$109.65
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $218.78	Professional	TC	$138.04	$173.78	$218.78
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $363.08 / $645.65	Professional		$181.97	$363.08	$645.65
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $147.91	Professional	26	$60.26	$83.18	$147.91
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $257.04 / $512.86	Professional	TC	$117.49	$257.04	$512.86
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $229.09 / $398.11	Professional		$213.80	$229.09	$398.11
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $125.89	Professional	26	$75.86	$85.11	$125.89
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $40.74 / $43.65 / $45.71	Professional	52	$40.74	$43.65	$45.71
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $229.09 / $234.42	Professional	TC	$194.98	$229.09	$234.42
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $602.56 / $602.56	Professional	26	$138.04	$602.56	$602.56
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $128.82 / $416.87	Facility	26	$70.79	$128.82	$416.87
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $426.58 / $1,000.00	Professional		$213.80	$426.58	$1,000.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $114.82 / $251.19	Professional	26	$67.61	$114.82	$251.19
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $109.65 / $190.55 / $549.54	Professional	52	$109.65	$190.55	$549.54
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $269.15 / $616.60	Professional	TC	$141.25	$269.15	$616.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $354.81 / $707.95	Professional		$114.82	$354.81	$707.95
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $69.18 / $81.28	Facility	26	$69.18	$69.18	$81.28
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $323.59 / $354.81	Professional		$100.00	$323.59	$354.81
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $69.18 / $72.44	Professional	26	$67.61	$69.18	$72.44
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $125.89 / $138.04	Professional	TC	$123.03	$125.89	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $288.40 / $588.84	Professional		$190.55	$288.40	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $134.90	Professional	26	$60.26	$75.86	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $181.97 / $489.78	Professional	TC	$125.89	$181.97	$489.78