Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.80 / $223.74 / $364.02	Facility		$68.80	$223.74	$364.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.65 / $12.55 / $31.27	Facility	26	$9.65	$12.55	$31.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.46 / $165.56 / $364.81	Facility	TC	$36.46	$165.56	$364.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.79 / $52.12 / $158.81	Professional		$34.79	$52.12	$158.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $14.33 / $41.00	Professional	26	$9.59	$14.33	$41.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.73 / $32.67 / $83.84	Professional	TC	$23.73	$32.67	$83.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.60 / $31.22 / $72.40	Professional		$26.60	$31.22	$72.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $10.03 / $17.70	Professional	26	$8.08	$10.03	$17.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.49 / $30.71 / $43.02	Professional	TC	$20.49	$30.71	$43.02
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $2,676.95 / $2,676.95 / $2,676.95	Facility		$2,676.95	$2,676.95	$2,676.95
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $46.01 / $49.97 / $80.91	Professional		$46.01	$49.97	$80.91
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $12.44 / $16.09 / $110.17	Professional	26	$12.44	$16.09	$110.17
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $8,639.91 / $79,506.39	Facility		$5,000.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Facility Modifier TC Low / Median / High Price $117.39 / $156.77 / $208.98	Facility	TC	$117.39	$156.77	$208.98
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $55.46 / $82.21	Professional		$38.36	$55.46	$82.21
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $17.38 / $24.81	Professional	26	$10.72	$17.38	$24.81
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $27.66 / $37.65 / $57.39	Professional	TC	$27.66	$37.65	$57.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $36.69 / $80.70 / $261.12	Facility		$36.69	$80.70	$261.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $12.30	Facility	26	$12.30	$12.30	$12.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $32.79 / $32.79 / $32.79	Facility	TC	$32.79	$32.79	$32.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.74 / $45.61 / $72.97	Professional		$29.74	$45.61	$72.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $13.36 / $21.36	Professional	26	$8.36	$13.36	$21.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.99 / $32.25 / $53.12	Professional	TC	$20.99	$32.25	$53.12
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $44.89 / $51.36 / $61.86	Professional		$44.89	$51.36	$61.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.76 / $14.15 / $22.26	Professional	26	$11.76	$14.15	$22.26
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.13 / $41.18 / $58.61	Professional	TC	$33.13	$41.18	$58.61
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $104.97 / $217.41 / $351.46	Facility		$104.97	$217.41	$351.46
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $185.00 / $314.33 / $462.20	Facility	TC	$185.00	$314.33	$462.20
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.93 / $46.76 / $57.78	Professional		$39.93	$46.76	$57.78
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $12.85 / $18.32	Professional	26	$11.43	$12.85	$18.32
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.54 / $42.01 / $49.86	Professional	TC	$30.54	$42.01	$49.86
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $2,676.95 / $2,676.95 / $3,391.48	Facility		$2,676.95	$2,676.95	$3,391.48
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $46.01 / $49.97 / $80.91	Professional		$46.01	$49.97	$80.91
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $14.56 / $104.17	Professional	26	$11.32	$14.56	$104.17
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $54.66 / $214.55 / $395.01	Facility		$54.66	$214.55	$395.01
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $9.65 / $13.32 / $31.27	Facility	26	$9.65	$13.32	$31.27
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $32.58 / $135.50 / $443.50	Facility	TC	$32.58	$135.50	$443.50
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $35.54 / $52.20 / $140.12	Professional		$35.54	$52.20	$140.12
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $9.88 / $14.39 / $33.27	Professional	26	$9.88	$14.39	$33.27
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $25.15 / $35.36 / $75.38	Professional	TC	$25.15	$35.36	$75.38
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 $11.19 / $38.47 / $67.72	Professional		$11.19	$38.47	$67.72
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $35.00 / $78.34 / $342.91	Facility		$35.00	$78.34	$342.91
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $7.17 / $12.30 / $12.30	Facility	26	$7.17	$12.30	$12.30
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $17.98 / $32.79 / $32.79	Facility	TC	$17.98	$32.79	$32.79
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $29.95 / $45.25 / $72.62	Professional		$29.95	$45.25	$72.62
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $13.24 / $21.78	Professional	26	$8.36	$13.24	$21.78
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.71 / $32.39 / $50.62	Professional	TC	$21.71	$32.39	$50.62
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $38.04 / $38.42 / $38.42	Facility		$38.04	$38.42	$38.42
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.61 / $10.61 / $12.00	Facility	26	$10.61	$10.61	$12.00
UPMC Health Plan Facility/Professional Facility Modifier TC Low / Median / High Price $26.05 / $27.81 / $27.81	Facility	TC	$26.05	$27.81	$27.81
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $37.84 / $38.42 / $41.64	Professional		$37.84	$38.42	$41.64
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $10.61 / $12.00	Professional	26	$10.35	$10.61	$12.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $26.05 / $27.81 / $30.62	Professional	TC	$26.05	$27.81	$30.62
United Facility/Professional Professional Modifier Low / Median / High Price $33.03 / $40.36 / $68.73	Professional		$33.03	$40.36	$68.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.99 / $12.46 / $20.95	Professional	26	$9.99	$12.46	$20.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.83 / $29.62 / $48.24	Professional	TC	$22.83	$29.62	$48.24