Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.46 / $74.05 / $98.36	Facility	26	$51.46	$74.05	$98.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.23 / $181.84 / $687.35	Professional		$126.23	$181.84	$687.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $54.25 / $169.35	Professional	26	$45.76	$54.25	$169.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $63.12 / $72.93 / $140.38	Professional	52	$63.12	$72.93	$140.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.75 / $159.05 / $401.61	Professional	TC	$79.75	$159.05	$401.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.38 / $101.01 / $127.07	Professional		$88.38	$101.01	$127.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $59.34 / $84.18	Professional	26	$38.65	$59.34	$84.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.83 / $123.48 / $125.00	Professional	TC	$83.83	$123.48	$125.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $59.19 / $75.61 / $561.22	Professional	26	$59.19	$75.61	$561.22
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $131.43 / $136.38 / $477.47	Professional		$131.43	$136.38	$477.47
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $51.01 / $83.16 / $134.72	Professional	26	$51.01	$83.16	$134.72
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $80.41 / $139.13 / $374.98	Professional	TC	$80.41	$139.13	$374.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.99 / $253.32 / $461.69	Professional		$123.99	$253.32	$461.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.29 / $63.95 / $101.75	Professional	26	$37.29	$63.95	$101.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.01 / $164.50 / $333.31	Professional	TC	$83.01	$164.50	$333.31
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $157.41 / $208.34 / $675.73	Professional		$157.41	$208.34	$675.73
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.84 / $67.03 / $105.80	Professional	26	$55.84	$67.03	$105.80
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.22 / $119.84 / $170.70	Professional	TC	$96.22	$119.84	$170.70
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $145.03 / $169.00 / $304.22	Professional		$145.03	$169.00	$304.22
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.82 / $63.45 / $88.96	Professional	26	$55.82	$63.45	$88.96
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.40 / $150.38 / $240.12	Professional	TC	$96.40	$150.38	$240.12
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $53.62 / $69.11 / $561.22	Professional	26	$53.62	$69.11	$561.22
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $49.01 / $71.06 / $155.41	Facility	26	$49.01	$71.06	$155.41
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $128.93 / $184.62 / $619.23	Professional		$128.93	$184.62	$619.23
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $56.53 / $154.87	Professional	26	$46.89	$56.53	$154.87
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $63.41 / $78.28 / $169.78	Professional	52	$63.41	$78.28	$169.78
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $79.94 / $118.69 / $361.52	Professional	TC	$79.94	$118.69	$361.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.16 / $123.46 / $325.00	Professional		$54.16	$123.46	$325.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $37.97 / $58.64 / $58.64	Facility	26	$37.97	$58.64	$58.64
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $130.69 / $242.00 / $440.18	Professional		$130.69	$242.00	$440.18
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.45 / $64.06 / $101.75	Professional	26	$37.45	$64.06	$101.75
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.45 / $164.50 / $324.47	Professional	TC	$83.45	$164.50	$324.47
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $50.77 / $50.77 / $62.00	Facility	26	$50.77	$50.77	$62.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $131.21 / $132.97 / $289.00	Professional		$131.21	$132.97	$289.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $50.81 / $62.00	Professional	26	$49.45	$50.81	$62.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $80.40 / $82.19 / $227.00	Professional	TC	$80.40	$82.19	$227.00
United Facility/Professional Professional Modifier Low / Median / High Price $137.85 / $199.12 / $333.71	Professional		$137.85	$199.12	$333.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.53 / $64.33 / $107.40	Professional	26	$50.53	$64.33	$107.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.52 / $121.39 / $252.70	Professional	TC	$85.52	$121.39	$252.70