Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.18 / $78.38 / $139.83	Facility	26	$55.18	$78.38	$139.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.27 / $247.46 / $1,032.00	Professional		$145.27	$247.46	$1,032.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.75 / $61.67 / $210.87	Professional	26	$50.75	$61.67	$210.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.96 / $185.79 / $372.00	Professional	TC	$106.96	$185.79	$372.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $60.96 / $113.69 / $146.38	Professional		$60.96	$113.69	$146.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.74 / $73.11 / $97.48	Professional	26	$41.74	$73.11	$97.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.92 / $101.53 / $170.01	Professional	TC	$56.92	$101.53	$170.01
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $63.85 / $78.56 / $555.76	Professional	26	$63.85	$78.56	$555.76
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $164.36 / $170.57 / $418.62	Professional		$164.36	$170.57	$418.62
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $57.10 / $89.68 / $144.24	Professional	26	$57.10	$89.68	$144.24
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $113.47 / $199.19 / $589.42	Professional	TC	$113.47	$199.19	$589.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.06 / $312.01 / $553.09	Professional		$155.06	$312.01	$553.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.52 / $70.42 / $116.68	Professional	26	$40.52	$70.42	$116.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.98 / $215.58 / $415.02	Professional	TC	$112.98	$215.58	$415.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $197.85 / $262.31 / $808.06	Professional		$197.85	$262.31	$808.06
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.22 / $72.36 / $114.20	Professional	26	$60.22	$72.36	$114.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.87 / $162.90 / $232.01	Professional	TC	$130.87	$162.90	$232.01
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $1,181.73 / $1,181.73 / $1,181.73	Facility	26	$1,181.73	$1,181.73	$1,181.73
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $182.26 / $212.08 / $357.01	Professional		$182.26	$212.08	$357.01
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.52 / $69.20 / $96.07	Professional	26	$61.52	$69.20	$96.07
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $170.68 / $204.82 / $293.83	Professional	TC	$170.68	$204.82	$293.83
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $72.83 / $555.76	Professional	26	$57.89	$72.83	$555.76
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $55.18 / $76.20 / $167.19	Facility	26	$55.18	$76.20	$167.19
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $158.41 / $245.54 / $878.92	Professional		$158.41	$245.54	$878.92
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $51.19 / $66.66 / $183.57	Professional	26	$51.19	$66.66	$183.57
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $109.26 / $168.50 / $412.45	Professional	TC	$109.26	$168.50	$412.45
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.81 / $171.46 / $325.00	Professional		$62.81	$171.46	$325.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $40.89 / $63.24 / $63.24	Facility	26	$40.89	$63.24	$63.24
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $162.81 / $302.73 / $538.13	Professional		$162.81	$302.73	$538.13
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.24 / $70.36 / $120.16	Professional	26	$41.24	$70.36	$120.16
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $113.46 / $210.00 / $400.35	Professional	TC	$113.46	$210.00	$400.35
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $54.75 / $54.75 / $66.50	Facility	26	$54.75	$54.75	$66.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $163.96 / $166.34 / $337.50	Professional		$163.96	$166.34	$337.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $53.36 / $54.76 / $66.50	Professional	26	$53.36	$54.76	$66.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $109.20 / $111.59 / $271.00	Professional	TC	$109.20	$111.59	$271.00
United Facility/Professional Professional Modifier Low / Median / High Price $170.57 / $246.40 / $394.77	Professional		$170.57	$246.40	$394.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.30 / $70.13 / $123.83	Professional	26	$54.30	$70.13	$123.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $113.47 / $153.69 / $307.20	Professional	TC	$113.47	$153.69	$307.20