Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.77 / $105.21 / $241.92	Facility	26	$72.77	$105.21	$241.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $197.27 / $425.00 / $1,222.20	Professional		$197.27	$425.00	$1,222.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.15 / $140.00 / $341.37	Professional	26	$70.15	$140.00	$341.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.85 / $299.00 / $441.00	Professional	TC	$124.85	$299.00	$441.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $115.88 / $144.16 / $167.70	Professional		$115.88	$144.16	$167.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $99.24 / $121.67	Professional	26	$53.20	$99.24	$121.67
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.14 / $123.14 / $123.14	Professional	TC	$123.14	$123.14	$123.14
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $218.57 / $288.06 / $3,149.14	Professional		$218.57	$288.06	$3,149.14
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $81.38 / $94.52 / $634.29	Professional	26	$81.38	$94.52	$634.29
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $199.02 / $312.97 / $930.46	Professional		$199.02	$312.97	$930.46
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $74.09 / $114.14 / $186.32	Professional	26	$74.09	$114.14	$186.32
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $124.92 / $205.17 / $788.64	Professional	TC	$124.92	$205.17	$788.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.77 / $385.93 / $785.66	Professional		$166.77	$385.93	$785.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.47 / $89.32 / $143.76	Professional	26	$52.47	$89.32	$143.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.54 / $297.50 / $666.92	Professional	TC	$111.54	$297.50	$666.92
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $226.01 / $299.41 / $1,300.25	Professional		$226.01	$299.41	$1,300.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.79 / $92.18 / $145.44	Professional	26	$76.79	$92.18	$145.44
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.52 / $176.16 / $250.91	Professional	TC	$141.52	$176.16	$250.91
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $220.18 / $242.20 / $387.41	Professional		$220.18	$242.20	$387.41
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.02 / $89.52 / $130.94	Professional	26	$78.02	$89.52	$130.94
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $184.81 / $221.10 / $221.77	Professional	TC	$184.81	$221.10	$221.77
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $214.68 / $265.27 / $1,099.50	Professional		$214.68	$265.27	$1,099.50
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $87.04 / $169.59	Professional	26	$73.73	$87.04	$169.59
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $70.90 / $102.80 / $249.47	Facility	26	$70.90	$102.80	$249.47
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $197.27 / $425.00 / $1,254.92	Professional		$197.27	$425.00	$1,254.92
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $70.15 / $126.00 / $322.00	Professional	26	$70.15	$126.00	$322.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $126.37 / $281.41 / $663.78	Professional	TC	$126.37	$281.41	$663.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $78.88 / $191.04 / $539.10	Professional		$78.88	$191.04	$539.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.55 / $80.26 / $80.26	Facility	26	$52.55	$80.26	$80.26
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $179.19 / $377.98 / $775.25	Professional		$179.19	$377.98	$775.25
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.43 / $89.32 / $143.76	Professional	26	$53.43	$89.32	$143.76
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.12 / $269.27 / $652.46	Professional	TC	$116.12	$269.27	$652.46
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $69.68 / $69.68 / $87.00	Facility	26	$69.68	$69.68	$87.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $188.50 / $191.07 / $559.50	Professional		$188.50	$191.07	$559.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $67.89 / $69.72 / $87.00	Professional	26	$67.89	$69.72	$87.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $118.78 / $121.39 / $472.50	Professional	TC	$118.78	$121.39	$472.50
United Facility/Professional Professional Modifier Low / Median / High Price $189.05 / $291.19 / $604.09	Professional		$189.05	$291.19	$604.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.30 / $83.21 / $140.04	Professional	26	$67.30	$83.21	$140.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $121.75 / $175.86 / $507.95	Professional	TC	$121.75	$175.86	$507.95