Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $89.13 / $186.21	Facility	26	$48.98	$89.13	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $218.78 / $851.14	Professional		$125.89	$218.78	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $177.83	Professional	26	$46.77	$58.88	$177.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $69.18 / $346.74 / $741.31	Professional	52	$69.18	$346.74	$741.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $141.25 / $457.09	Professional	TC	$83.18	$141.25	$457.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $104.71 / $177.83	Professional		$81.28	$104.71	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $47.86 / $77.62	Professional	26	$38.02	$47.86	$77.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $104.71 / $125.89	Professional	TC	$74.13	$104.71	$125.89
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $478.63 / $478.63	Professional		$204.17	$478.63	$478.63
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $125.89	Professional	26	$51.29	$74.13	$125.89
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $125.89 / $371.54	Professional	TC	$81.28	$125.89	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $57.54 / $83.18	Facility	26	$12.59	$57.54	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $257.04 / $446.68	Professional		$131.83	$257.04	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $66.07 / $112.20	Professional	26	$37.15	$66.07	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $165.96 / $323.59	Professional	TC	$83.18	$165.96	$323.59
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $177.83 / $223.87	Professional		$138.04	$177.83	$223.87
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $81.28	Professional	26	$50.12	$66.07	$81.28
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $114.82 / $144.54	Professional	TC	$89.13	$114.82	$144.54
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $213.80 / $398.11	Professional		$138.04	$213.80	$398.11
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $114.82	Professional	26	$46.77	$63.10	$114.82
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $162.18 / $288.40	Professional	TC	$83.18	$162.18	$288.40
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $158.49 / $177.83	Professional		$147.91	$158.49	$177.83
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $61.66 / $85.11	Professional	26	$56.23	$61.66	$85.11
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $151.36 / $245.47	Professional	TC	$125.89	$151.36	$245.47
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $512.86 / $512.86	Professional	26	$107.15	$512.86	$512.86
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $85.11 / $177.83	Facility	26	$48.98	$85.11	$177.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $229.09 / $537.03	Professional		$134.90	$229.09	$537.03
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $64.57 / $162.18	Professional	26	$47.86	$64.57	$162.18
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $69.18 / $331.13 / $741.31	Professional	52	$69.18	$331.13	$741.31
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $144.54 / $323.59	Professional	TC	$85.11	$144.54	$323.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $239.88 / $354.81	Professional		$75.86	$239.88	$354.81
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $181.97 / $288.40	Professional		$43.65	$181.97	$288.40
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	26	$61.66	$61.66	$61.66
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	TC	$229.09	$229.09	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $199.53 / $338.84	Professional		$131.83	$199.53	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $97.72	Professional	26	$44.67	$58.88	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $123.03 / $245.47	Professional	TC	$83.18	$123.03	$245.47