Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.28 / $136.34 / $249.47	Facility	26	$108.28	$136.34	$249.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.94 / $465.69 / $2,507.01	Professional		$347.94	$465.69	$2,507.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.17 / $140.00 / $386.40	Professional	26	$101.17	$140.00	$386.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $243.60 / $299.00 / $825.76	Professional	TC	$243.60	$299.00	$825.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $178.18 / $253.50 / $324.14	Professional		$178.18	$253.50	$324.14
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $127.99 / $172.29	Professional	26	$80.70	$127.99	$172.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $236.20 / $352.31 / $352.31	Professional	TC	$236.20	$352.31	$352.31
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $384.04 / $520.92 / $2,862.80	Professional		$384.04	$520.92	$2,862.80
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $121.08 / $140.47 / $3,430.57	Professional	26	$121.08	$140.47	$3,430.57
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $362.19 / $571.84 / $1,757.90	Professional		$362.19	$571.84	$1,757.90
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $114.19 / $168.57 / $262.58	Professional	26	$114.19	$168.57	$262.58
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $248.00 / $395.74 / $1,558.03	Professional	TC	$248.00	$395.74	$1,558.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.86 / $118.86 / $118.86	Facility	26	$118.86	$118.86	$118.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $327.85 / $720.14 / $1,358.47	Professional		$327.85	$720.14	$1,358.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.38 / $129.34 / $209.27	Professional	26	$75.38	$129.34	$209.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $233.98 / $573.80 / $1,162.84	Professional	TC	$233.98	$573.80	$1,162.84
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $399.15 / $529.85 / $2,224.06	Professional		$399.15	$529.85	$2,224.06
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.35 / $137.09 / $216.15	Professional	26	$114.35	$137.09	$216.15
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $271.19 / $337.70 / $481.05	Professional	TC	$271.19	$337.70	$481.05
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $364.32 / $389.73 / $851.02	Professional		$364.32	$389.73	$851.02
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.53 / $127.09 / $180.23	Professional	26	$115.53	$127.09	$180.23
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $350.98 / $427.76 / $1,005.10	Professional	TC	$350.98	$427.76	$1,005.10
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $379.83 / $494.26 / $1,981.54	Professional		$379.83	$494.26	$1,981.54
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $109.67 / $129.36 / $500.00	Professional	26	$109.67	$129.36	$500.00
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $104.87 / $148.63 / $303.33	Facility	26	$104.87	$148.63	$303.33
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $351.45 / $475.00 / $2,105.00	Professional		$351.45	$475.00	$2,105.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $104.34 / $150.25 / $333.00	Professional	26	$104.34	$150.25	$333.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $246.57 / $328.00 / $783.89	Professional	TC	$246.57	$328.00	$783.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $138.96 / $381.57 / $763.90	Professional		$138.96	$381.57	$763.90
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.04 / $118.86 / $118.86	Facility	26	$74.04	$118.86	$118.86
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $335.00 / $656.61 / $1,336.98	Professional		$335.00	$656.61	$1,336.98
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.34 / $127.97 / $209.27	Professional	26	$78.34	$127.97	$209.27
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $235.17 / $525.41 / $1,138.40	Professional	TC	$235.17	$525.41	$1,138.40
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $102.91 / $102.91 / $119.70	Facility	26	$102.91	$102.91	$119.70
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $334.00 / $339.05 / $1,046.70	Professional		$334.00	$339.05	$1,046.70
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $100.30 / $102.93 / $119.70	Professional	26	$100.30	$102.93	$119.70
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $231.07 / $236.14 / $927.00	Professional	TC	$231.07	$236.14	$927.00
United Facility/Professional Professional Modifier Low / Median / High Price $339.06 / $499.56 / $1,022.03	Professional		$339.06	$499.56	$1,022.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.31 / $121.97 / $205.83	Professional	26	$97.31	$121.97	$205.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $240.14 / $341.68 / $872.74	Professional	TC	$240.14	$341.68	$872.74