Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.20 / $126.00 / $241.92	Facility	26	$70.20	$126.00	$241.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $238.82 / $425.00 / $1,542.43	Professional		$238.82	$425.00	$1,542.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.20 / $134.41 / $271.00	Professional	26	$70.20	$134.41	$271.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.21 / $200.00 / $237.50	Professional	52	$118.21	$200.00	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.61 / $299.00 / $502.50	Professional	TC	$168.61	$299.00	$502.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $150.77 / $173.78 / $218.95	Professional		$150.77	$173.78	$218.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.33 / $95.45 / $122.17	Professional	26	$53.33	$95.45	$122.17
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $241.14 / $241.14 / $241.14	Professional	TC	$241.14	$241.14	$241.14
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $260.19 / $353.29 / $2,646.28	Professional		$260.19	$353.29	$2,646.28
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $236.92 / $376.61 / $832.79	Professional		$236.92	$376.61	$832.79
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $73.04 / $112.52 / $170.20	Professional	26	$73.04	$112.52	$170.20
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $163.89 / $264.10 / $703.28	Professional	TC	$163.89	$264.10	$703.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $222.55 / $457.46 / $859.41	Professional		$222.55	$457.46	$859.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.47 / $84.61 / $138.12	Professional	26	$50.47	$84.61	$138.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $160.13 / $342.78 / $735.09	Professional	TC	$160.13	$342.78	$735.09
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $270.51 / $358.92 / $1,306.15	Professional		$270.51	$358.92	$1,306.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.68 / $90.85 / $143.33	Professional	26	$75.68	$90.85	$143.33
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $185.61 / $231.14 / $329.25	Professional	TC	$185.61	$231.14	$329.25
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $244.13 / $268.55 / $608.85	Professional		$244.13	$268.55	$608.85
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.27 / $85.00 / $121.91	Professional	26	$77.27	$85.00	$121.91
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $42.50 / $310.54 / $316.64	Professional	52	$42.50	$310.54	$316.64
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $244.31 / $291.17 / $293.17	Professional	TC	$244.31	$291.17	$293.17
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $257.58 / $325.33 / $1,035.49	Professional		$257.58	$325.33	$1,035.49
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $70.20 / $103.72 / $374.22	Facility	26	$70.20	$103.72	$374.22
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $238.82 / $431.22 / $1,502.21	Professional		$238.82	$431.22	$1,502.21
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $70.20 / $126.00 / $271.00	Professional	26	$70.20	$126.00	$271.00
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $119.41 / $207.31 / $518.50	Professional	52	$119.41	$207.31	$518.50
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $168.61 / $299.00 / $729.56	Professional	TC	$168.61	$299.00	$729.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.88 / $261.41 / $700.00	Professional		$95.88	$261.41	$700.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $48.05 / $79.45 / $79.45	Facility	26	$48.05	$79.45	$79.45
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $232.69 / $447.67 / $854.35	Professional		$232.69	$447.67	$854.35
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.97 / $84.20 / $141.00	Professional	26	$52.97	$84.20	$141.00
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $160.96 / $338.77 / $700.06	Professional	TC	$160.96	$338.77	$700.06
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $68.69 / $68.69 / $89.00	Facility	26	$68.69	$68.69	$89.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $226.46 / $229.92 / $507.00	Professional		$226.46	$229.92	$507.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $66.91 / $68.73 / $89.00	Professional	26	$66.91	$68.73	$89.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $157.72 / $161.22 / $418.00	Professional	TC	$157.72	$161.22	$418.00
United Facility/Professional Professional Modifier Low / Median / High Price $231.01 / $341.15 / $632.71	Professional		$231.01	$341.15	$632.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.20 / $82.58 / $143.46	Professional	26	$65.20	$82.58	$143.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.66 / $237.84 / $485.70	Professional	TC	$164.66	$237.84	$485.70