Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.15 / $254.87 / $376.22	Facility		$75.15	$254.87	$376.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.18 / $11.37 / $28.33	Facility	26	$9.18	$11.37	$28.33
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.54 / $178.12 / $364.02	Facility	TC	$26.54	$178.12	$364.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.69 / $37.53 / $136.88	Professional		$28.69	$37.53	$136.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.69 / $12.53 / $38.40	Professional	26	$8.69	$12.53	$38.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $23.81 / $52.43	Professional	TC	$18.82	$23.81	$52.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $22.20 / $25.35 / $60.32	Professional		$22.20	$25.35	$60.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.36 / $10.76 / $16.05	Professional	26	$7.36	$10.76	$16.05
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.11 / $34.63 / $34.63	Professional	TC	$17.11	$34.63	$34.63
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $48.13 / $103.40 / $839.93	Facility		$48.13	$103.40	$839.93
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $10.90 / $13.20 / $110.17	Professional	26	$10.90	$13.20	$110.17
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $123.75 / $5,000.00 / $77,850.02	Facility		$123.75	$5,000.00	$77,850.02
Capital Blue Cross Facility/Professional Facility Modifier TC Low / Median / High Price $97.21 / $129.82 / $173.06	Facility	TC	$97.21	$129.82	$173.06
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $31.97 / $51.75 / $80.64	Professional		$31.97	$51.75	$80.64
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $9.72 / $15.74 / $24.81	Professional	26	$9.72	$15.74	$24.81
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $22.25 / $33.94 / $55.86	Professional	TC	$22.25	$33.94	$55.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $29.49 / $64.03 / $261.12	Facility		$29.49	$64.03	$261.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.16 / $11.16 / $11.16	Facility	26	$11.16	$11.16	$11.16
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $26.10 / $26.10 / $26.10	Facility	TC	$26.10	$26.10	$26.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.02 / $40.71 / $63.37	Professional		$26.02	$40.71	$63.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.77 / $20.70	Professional	26	$7.59	$12.77	$20.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.67 / $28.09 / $43.94	Professional	TC	$17.67	$28.09	$43.94
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $37.32 / $44.34 / $55.42	Professional		$37.32	$44.34	$55.42
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.67 / $12.81 / $20.14	Professional	26	$10.67	$12.81	$20.14
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.67 / $33.11 / $47.12	Professional	TC	$26.67	$33.11	$47.12
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $101.39 / $216.75 / $374.25	Facility		$101.39	$216.75	$374.25
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $147.30 / $279.11 / $509.04	Facility	TC	$147.30	$279.11	$509.04
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.72 / $39.14 / $45.52	Professional		$35.72	$39.14	$45.52
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.26 / $11.89 / $16.62	Professional	26	$10.26	$11.89	$16.62
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $28.29 / $40.11	Professional	TC	$25.70	$28.29	$40.11
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $73.37 / $105.31 / $226.91	Facility		$73.37	$105.31	$226.91
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $33.61 / $33.61 / $33.61	Professional		$33.61	$33.61	$33.61
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $13.20 / $16.55	Professional	26	$11.28	$13.20	$16.55
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $45.54 / $216.40 / $393.59	Facility		$45.54	$216.40	$393.59
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $9.18 / $12.68 / $29.81	Facility	26	$9.18	$12.68	$29.81
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $25.92 / $99.33 / $398.92	Facility	TC	$25.92	$99.33	$398.92
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $29.32 / $42.78 / $99.41	Professional		$29.32	$42.78	$99.41
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $9.01 / $13.82 / $30.14	Professional	26	$9.01	$13.82	$30.14
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $19.94 / $27.49 / $54.00	Professional	TC	$19.94	$27.49	$54.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $164.84 / $169.49 / $235.40	Facility		$164.84	$169.49	$235.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.32 / $31.48 / $56.57	Professional		$10.32	$31.48	$56.57
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $27.77 / $62.16 / $342.91	Facility		$27.77	$62.16	$342.91
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.17 / $11.16 / $11.16	Facility	26	$7.17	$11.16	$11.16
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $17.48 / $26.10 / $26.10	Facility	TC	$17.48	$26.10	$26.10
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $26.25 / $40.65 / $61.83	Professional		$26.25	$40.65	$61.83
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $12.77 / $20.70	Professional	26	$7.83	$12.77	$20.70
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.19 / $28.05 / $43.94	Professional	TC	$18.19	$28.05	$43.94
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $31.74 / $31.74 / $37.00	Facility		$31.74	$31.74	$37.00
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $9.61 / $9.61 / $12.00	Facility	26	$9.61	$9.61	$12.00
UPMC Health Plan Facility/Professional Facility Modifier TC Low / Median / High Price $22.12 / $22.12 / $25.00	Facility	TC	$22.12	$22.12	$25.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $31.29 / $31.74 / $37.00	Professional		$31.29	$31.74	$37.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.38 / $9.61 / $12.00	Professional	26	$9.38	$9.61	$12.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.68 / $22.12 / $25.00	Professional	TC	$21.68	$22.12	$25.00
United Facility/Professional Professional Modifier Low / Median / High Price $27.51 / $35.15 / $57.79	Professional		$27.51	$35.15	$57.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.24 / $11.52 / $19.04	Professional	26	$9.24	$11.52	$19.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.67 / $23.81 / $39.63	Professional	TC	$18.67	$23.81	$39.63