Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $169.82 / $467.74	Facility	26	$66.07	$169.82	$467.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $363.08 / $1,445.44	Professional		$89.13	$363.08	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $125.89 / $354.81	Professional	26	$64.57	$125.89	$354.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.42 / $1,096.48 / $1,949.84	Professional	50	$234.42	$1,096.48	$1,949.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $162.18 / $501.19	Professional	52	$31.62	$162.18	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $309.03 / $933.25	Professional	TC	$144.54	$309.03	$933.25
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $245.47	Professional		$138.04	$169.82	$245.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $107.15	Professional	26	$51.29	$91.20	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $125.89 / $213.80	Professional	TC	$104.71	$125.89	$213.80
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $354.81 / $575.44	Professional		$257.04	$354.81	$575.44
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $87.10 / $158.49	Professional	26	$81.28	$87.10	$158.49
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $512.86 / $707.95 / $1,148.15	Professional	50	$512.86	$707.95	$1,148.15
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $251.19 / $707.95	Professional	TC	$173.78	$251.19	$707.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.49 / $72.44 / $104.71	Facility	26	$15.49	$72.44	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $407.38 / $758.58	Professional		$194.98	$407.38	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $134.90	Professional	26	$47.86	$79.43	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $302.00 / $660.69	Professional	TC	$131.83	$302.00	$660.69
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $288.40 / $1,047.13	Professional		$213.80	$288.40	$1,047.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $102.33	Professional	26	$63.10	$83.18	$102.33
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $245.47	Professional	TC	$151.36	$194.98	$245.47
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $354.81 / $616.60	Professional		$190.55	$354.81	$616.60
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $138.04	Professional	26	$54.95	$77.62	$138.04
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $288.40 / $446.68	Professional	TC	$128.82	$288.40	$446.68
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $234.42 / $416.87	Professional		$223.87	$234.42	$416.87
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $74.13 / $112.20	Professional	26	$67.61	$74.13	$112.20
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $39.81 / $128.82 / $128.82	Professional	52	$39.81	$128.82	$128.82
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $251.19 / $416.87	Professional	TC	$213.80	$251.19	$416.87
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $281.84 / $501.19	Professional		$234.42	$281.84	$501.19
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $79.43 / $104.71	Professional	26	$72.44	$79.43	$104.71
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $138.04 / $416.87	Facility	26	$66.07	$138.04	$416.87
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $407.38 / $1,071.52	Professional		$165.96	$407.38	$1,071.52
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $120.23 / $295.12	Professional	26	$66.07	$120.23	$295.12
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $478.63 / $1,096.48 / $1,949.84	Professional	50	$478.63	$1,096.48	$1,949.84
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $162.18 / $1,023.29	Professional	52	$31.62	$162.18	$1,023.29
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $295.12 / $645.65	Professional	TC	$154.88	$295.12	$645.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $446.68 / $707.95	Professional		$128.82	$446.68	$707.95
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $63.10 / $89.13	Facility	26	$63.10	$63.10	$89.13
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $457.09	Professional		$199.53	$302.00	$457.09
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $63.10 / $66.07	Professional	26	$61.66	$63.10	$66.07
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $138.04 / $151.36	Professional	TC	$134.90	$138.04	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $575.44	Professional		$199.53	$295.12	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $69.18 / $123.03	Professional	26	$54.95	$69.18	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $194.98 / $478.63	Professional	TC	$138.04	$194.98	$478.63