Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.13 / $142.05 / $398.16	Facility	26	$113.13	$142.05	$398.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.24 / $475.00 / $1,923.61	Professional		$331.24	$475.00	$1,923.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.27 / $168.21 / $438.76	Professional	26	$109.27	$168.21	$438.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.91 / $299.00 / $557.00	Professional	TC	$219.91	$299.00	$557.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $212.32 / $233.50 / $308.39	Professional		$212.32	$233.50	$308.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.38 / $117.32 / $205.70	Professional	26	$84.38	$117.32	$205.70
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $214.94 / $214.94 / $214.94	Professional	TC	$214.94	$214.94	$214.94
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $126.51 / $146.88 / $1,173.70	Professional	26	$126.51	$146.88	$1,173.70
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $345.04 / $544.08 / $1,806.98	Professional		$345.04	$544.08	$1,806.98
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $119.31 / $176.14 / $299.75	Professional	26	$119.31	$176.14	$299.75
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $225.74 / $360.00 / $1,578.86	Professional	TC	$225.74	$360.00	$1,578.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.22 / $124.22 / $124.22	Facility	26	$124.22	$124.22	$124.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $284.58 / $649.12 / $1,395.36	Professional		$284.58	$649.12	$1,395.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.84 / $139.94 / $223.07	Professional	26	$81.84	$139.94	$223.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.60 / $474.07 / $1,172.06	Professional	TC	$194.60	$474.07	$1,172.06
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $379.34 / $503.35 / $2,226.26	Professional		$379.34	$503.35	$2,226.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.54 / $143.28 / $225.79	Professional	26	$119.54	$143.28	$225.79
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $246.87 / $307.38 / $437.82	Professional	TC	$246.87	$307.38	$437.82
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $349.98 / $384.98 / $654.87	Professional		$349.98	$384.98	$654.87
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.78 / $140.00 / $199.52	Professional	26	$120.78	$140.00	$199.52
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $384.56 / $389.13 / $995.35	Professional	TC	$384.56	$389.13	$995.35
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $126.51 / $146.88 / $1,173.70	Professional	26	$126.51	$146.88	$1,173.70
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $109.27 / $155.30 / $374.22	Facility	26	$109.27	$155.30	$374.22
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $331.83 / $475.00 / $1,630.00	Professional		$331.83	$475.00	$1,630.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $109.27 / $168.00 / $360.00	Professional	26	$109.27	$168.00	$360.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $222.56 / $307.13 / $783.89	Professional	TC	$222.56	$307.13	$783.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $124.78 / $327.51 / $700.00	Professional		$124.78	$327.51	$700.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $84.61 / $124.22 / $124.22	Facility	26	$84.61	$124.22	$124.22
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $303.37 / $632.28 / $1,323.18	Professional		$303.37	$632.28	$1,323.18
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.98 / $142.21 / $223.07	Professional	26	$83.98	$142.21	$223.07
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.33 / $450.34 / $1,132.36	Professional	TC	$204.33	$450.34	$1,132.36
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $107.53 / $107.53 / $133.00	Facility	26	$107.53	$107.53	$133.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $317.01 / $321.54 / $1,051.00	Professional		$317.01	$321.54	$1,051.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $104.78 / $107.58 / $133.00	Professional	26	$104.78	$107.58	$133.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $209.43 / $214.01 / $918.00	Professional	TC	$209.43	$214.01	$918.00
United Facility/Professional Professional Modifier Low / Median / High Price $319.77 / $470.69 / $1,058.44	Professional		$319.77	$470.69	$1,058.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.68 / $128.63 / $217.76	Professional	26	$103.68	$128.63	$217.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $216.10 / $307.49 / $852.18	Professional	TC	$216.10	$307.49	$852.18