Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.46 / $63.71 / $178.64	Facility	26	$51.46	$63.71	$178.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.46 / $158.75 / $416.67	Professional		$130.46	$158.75	$416.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.76 / $54.75 / $145.35	Professional	26	$45.76	$54.75	$145.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.49 / $98.24 / $192.00	Professional	TC	$82.49	$98.24	$192.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $94.10 / $104.55 / $150.86	Professional		$94.10	$104.55	$150.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $54.94 / $84.08	Professional	26	$38.65	$54.94	$84.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.70 / $116.09 / $131.97	Professional	TC	$58.70	$116.09	$131.97
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $154.74 / $168.03 / $1,636.20	Professional		$154.74	$168.03	$1,636.20
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $53.13 / $59.19 / $535.04	Professional	26	$53.13	$59.19	$535.04
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $135.87 / $141.00 / $233.04	Professional		$135.87	$141.00	$233.04
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $51.01 / $52.93 / $84.32	Professional	26	$51.01	$52.93	$84.32
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $84.86 / $88.07 / $148.69	Professional	TC	$84.86	$88.07	$148.69
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 $107.20 / $178.87 / $286.64	Professional		$107.20	$178.87	$286.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.60 / $62.41 / $101.32	Professional	26	$36.60	$62.41	$101.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.59 / $112.73 / $182.08	Professional	TC	$70.59	$112.73	$182.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $162.99 / $194.63 / $373.82	Professional		$162.99	$194.63	$373.82
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 $101.61 / $126.41 / $180.00	Professional	TC	$101.61	$126.41	$180.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $162.13 / $174.81	Professional		$150.00	$162.13	$174.81
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.90 / $62.11 / $77.93	Professional	26	$53.90	$62.11	$77.93
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $132.15 / $158.22 / $158.58	Professional	TC	$132.15	$158.22	$158.58
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $141.97 / $159.43 / $1,636.20	Professional		$141.97	$159.43	$1,636.20
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $53.13 / $57.69 / $535.04	Professional	26	$53.13	$57.69	$535.04
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $49.00 / $67.63 / $178.64	Facility	26	$49.00	$67.63	$178.64
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $133.26 / $165.25 / $405.15	Professional		$133.26	$165.25	$405.15
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $47.97 / $58.23 / $131.07	Professional	26	$47.97	$58.23	$131.07
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $84.26 / $106.15 / $228.79	Professional	TC	$84.26	$106.15	$228.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.53 / $131.10 / $302.60	Professional		$54.53	$131.10	$302.60
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $115.20 / $181.28 / $290.27	Professional		$115.20	$181.28	$290.27
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.08 / $61.43 / $103.61	Professional	26	$37.08	$61.43	$103.61
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.58 / $112.73 / $188.95	Professional	TC	$73.58	$112.73	$188.95
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $50.77 / $50.77 / $57.21	Facility	26	$50.77	$50.77	$57.21
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $135.54 / $137.38 / $158.11	Professional		$135.54	$137.38	$158.11
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $49.45 / $50.81 / $57.21	Professional	26	$49.45	$50.81	$57.21
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $84.73 / $86.62 / $100.89	Professional	TC	$84.73	$86.62	$100.89
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $167.57 / $281.99	Professional		$134.36	$167.57	$281.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.21 / $60.72 / $98.82	Professional	26	$48.21	$60.72	$98.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.35 / $108.25 / $181.76	Professional	TC	$87.35	$108.25	$181.76