Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $190.55 / $416.87	Facility	26	$104.71	$190.55	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $549.54 / $2,511.89	Professional		$346.74	$549.54	$2,511.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $398.11	Professional	26	$102.33	$186.21	$398.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $1,258.93	Professional	TC	$245.47	$363.08	$1,258.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $269.15 / $478.63	Professional		$223.87	$269.15	$478.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $147.91 / $186.21	Professional	26	$83.18	$147.91	$186.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $295.12 / $354.81	Professional	TC	$151.36	$295.12	$354.81
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $478.63 / $1,202.26	Professional		$363.08	$478.63	$1,202.26
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $263.03	Professional	26	$114.82	$138.04	$263.03
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $338.84 / $1,096.48	Professional	TC	$245.47	$338.84	$1,096.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $120.23 / $169.82	Facility	26	$25.70	$120.23	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $691.83 / $1,348.96	Professional		$338.84	$691.83	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $131.83 / $218.78	Professional	26	$77.62	$131.83	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $524.81 / $1,122.02	Professional	TC	$239.88	$524.81	$1,122.02
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $467.74 / $1,584.89	Professional		$354.81	$467.74	$1,584.89
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $134.90 / $165.96	Professional	26	$102.33	$134.90	$165.96
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $316.23 / $398.11	Professional	TC	$251.19	$316.23	$398.11
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $549.54 / $1,047.13	Professional		$346.74	$549.54	$1,047.13
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $125.89 / $223.87	Professional	26	$91.20	$125.89	$223.87
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $446.68 / $870.96	Professional	TC	$234.42	$446.68	$870.96
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $407.38 / $851.14	Professional		$371.54	$407.38	$851.14
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $125.89 / $177.83	Professional	26	$114.82	$125.89	$177.83
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $426.58 / $1,000.00	Professional	TC	$354.81	$426.58	$1,000.00
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $2,089.30	Professional		$2,089.30	$2,089.30	$2,089.30
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $169.82	Professional	26	$109.65	$128.82	$169.82
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $165.96 / $416.87	Facility	26	$104.71	$165.96	$416.87
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $549.54 / $1,548.82	Professional		$354.81	$549.54	$1,548.82
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $162.18 / $346.74	Professional	26	$104.71	$162.18	$346.74
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $380.19 / $891.25	Professional	TC	$251.19	$380.19	$891.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $602.56 / $977.24	Professional		$173.78	$602.56	$977.24
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $120.23 / $120.23	Facility	26	$102.33	$120.23	$120.23
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $467.74	Professional		$295.12	$346.74	$467.74
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $104.71 / $120.23	Professional	26	$100.00	$104.71	$120.23
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $239.88 / $933.25	Professional	TC	$229.09	$239.88	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $1,071.52	Professional		$331.13	$501.19	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $199.53	Professional	26	$89.13	$112.20	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $346.74 / $870.96	Professional	TC	$234.42	$346.74	$870.96