Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $218.78 / $446.68	Facility		$47.86	$218.78	$446.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $19.05 / $38.02	Facility	26	$9.55	$19.05	$38.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $93.33 / $323.59	Facility	TC	$27.54	$93.33	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $56.23 / $186.21	Professional		$33.88	$56.23	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.49 / $46.77	Professional	26	$8.91	$15.49	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $114.82 / $186.21	Professional	50	$38.02	$114.82	$186.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $38.02 / $147.91 / $162.18	Professional	52	$38.02	$147.91	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $93.33	Professional	TC	$23.99	$33.88	$93.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.88 / $57.54	Professional		$26.92	$33.88	$57.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $11.22 / $17.78	Professional	26	$7.41	$11.22	$17.78
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	50	$52.48	$52.48	$52.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.84 / $38.90	Professional	TC	$23.44	$28.84	$38.90
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,011.87 / $8,511.38 / $77,624.71	Facility		$5,011.87	$8,511.38	$77,624.71
Capital Blue Cross Facility/Professional Facility Modifier TC Low / Median / High Price $120.23 / $169.82 / $245.47	Facility	TC	$120.23	$169.82	$245.47
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $46.77 / $69.18	Professional		$39.81	$46.77	$69.18
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.13 / $21.38	Professional	26	$10.72	$14.13	$21.38
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $32.36 / $51.29	Professional	TC	$29.51	$32.36	$51.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $85.11 / $275.42	Facility		$38.90	$85.11	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.08 / $33.11 / $47.86	Facility	TC	$7.08	$33.11	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $47.86 / $79.43	Professional		$30.90	$47.86	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $13.80 / $22.91	Professional	26	$8.32	$13.80	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $34.67 / $60.26	Professional	TC	$22.39	$34.67	$60.26
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $56.23 / $70.79	Professional		$44.67	$56.23	$70.79
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.13 / $17.38	Professional	26	$10.96	$14.13	$17.38
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $42.66 / $53.70	Professional	TC	$33.11	$42.66	$53.70
Geisinger Facility/Professional Facility Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Facility		$60.26	$60.26	$60.26
Geisinger Facility/Professional Facility Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Facility	TC	$41.69	$41.69	$41.69
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $44.67 / $87.10	Professional		$30.20	$44.67	$87.10
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $12.30 / $22.91	Professional	26	$9.33	$12.30	$22.91
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $33.11 / $63.10	Professional	TC	$20.89	$33.11	$63.10
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $204.17 / $302.00	Facility		$56.23	$204.17	$302.00
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $138.04 / $389.05 / $602.56	Facility	TC	$138.04	$389.05	$602.56
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $50.12 / $52.48	Professional		$45.71	$50.12	$52.48
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $13.49 / $19.05	Professional	26	$11.48	$13.49	$19.05
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	TC	$43.65	$43.65	$43.65
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $109.65 / $251.19	Facility		$81.28	$109.65	$251.19
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $213.80 / $436.52	Facility		$45.71	$213.80	$436.52
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $15.85 / $38.02	Facility	26	$9.55	$15.85	$38.02
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $27.54 / $93.33 / $398.11	Facility	TC	$27.54	$93.33	$398.11
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $51.29 / $114.82	Professional		$33.88	$51.29	$114.82
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.45 / $30.20	Professional	26	$8.91	$14.45	$30.20
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $117.49 / $186.21	Professional	50	$38.02	$117.49	$186.21
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $17.78 / $72.44	Professional	52	$17.78	$17.78	$72.44
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $74.13	Professional	TC	$23.99	$36.31	$74.13
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $169.82 / $234.42	Facility		$162.18	$169.82	$234.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $46.77 / $190.55	Professional		$19.95	$46.77	$190.55
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $27.54 / $75.86	Facility		$22.39	$27.54	$75.86
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $12.59 / $12.59	Facility	26	$10.72	$12.59	$12.59
UPMC Health Plan Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $28.84 / $28.84	Facility	TC	$28.84	$28.84	$28.84
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $27.54 / $75.86	Professional		$21.88	$27.54	$75.86
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $10.72 / $12.59	Professional	26	$10.23	$10.72	$12.59
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $28.84 / $32.36	Professional	TC	$28.18	$28.84	$32.36
United Facility/Professional Facility Modifier Low / Median / High Price $158.49 / $281.84 / $371.54	Facility		$158.49	$281.84	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $40.74 / $69.18	Professional		$33.11	$40.74	$69.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.02 / $20.42	Professional	26	$9.12	$12.02	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $29.51 / $50.12	Professional	TC	$23.44	$29.51	$50.12