Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.97 / $102.66 / $288.10	Facility	26	$78.97	$102.66	$288.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $178.05 / $219.39 / $906.00	Professional		$178.05	$219.39	$906.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.88 / $89.37 / $276.25	Professional	26	$73.88	$89.37	$276.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.99 / $133.69 / $564.00	Professional	TC	$96.99	$133.69	$564.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $122.54 / $144.61 / $162.11	Professional		$122.54	$144.61	$162.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $84.76 / $135.53	Professional	26	$62.31	$84.76	$135.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.19 / $155.19 / $155.19	Professional	TC	$74.19	$155.19	$155.19
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $211.22 / $267.23 / $3,640.00	Professional		$211.22	$267.23	$3,640.00
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $95.41 / $128.93 / $901.55	Professional	26	$95.41	$128.93	$901.55
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $182.02 / $300.45 / $440.39	Professional		$182.02	$300.45	$440.39
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $82.22 / $134.22 / $175.90	Professional	26	$82.22	$134.22	$175.90
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $99.80 / $166.20 / $264.49	Professional	TC	$99.80	$166.20	$264.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.97 / $253.05 / $414.43	Professional		$157.97	$253.05	$414.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.18 / $101.48 / $165.84	Professional	26	$60.18	$101.48	$165.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.59 / $152.69 / $243.66	Professional	TC	$88.59	$152.69	$243.66
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $216.84 / $279.08 / $440.29	Professional		$216.84	$279.08	$440.29
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.98 / $112.40 / $170.54	Professional	26	$89.98	$112.40	$170.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.47 / $148.69 / $211.75	Professional	TC	$119.47	$148.69	$211.75
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $211.18 / $224.55 / $325.76	Professional		$211.18	$224.55	$325.76
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $90.37 / $98.98 / $141.52	Professional	26	$90.37	$98.98	$141.52
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $119.66 / $155.56 / $186.67	Professional	TC	$119.66	$155.56	$186.67
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $205.39 / $246.09 / $3,640.00	Professional		$205.39	$246.09	$3,640.00
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $92.00 / $123.67 / $901.55	Professional	26	$92.00	$123.67	$901.55
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $78.97 / $114.50 / $298.13	Facility	26	$78.97	$114.50	$298.13
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $178.05 / $231.82 / $867.00	Professional		$178.05	$231.82	$867.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $77.31 / $91.30 / $244.30	Professional	26	$77.31	$91.30	$244.30
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $99.08 / $136.56 / $368.16	Professional	TC	$99.08	$136.56	$368.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.06 / $167.43 / $325.00	Professional		$82.06	$167.43	$325.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $157.97 / $254.64 / $424.35	Professional		$157.97	$254.64	$424.35
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.18 / $100.84 / $168.31	Professional	26	$60.18	$100.84	$168.31
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $94.15 / $152.49 / $243.66	Professional	TC	$94.15	$152.49	$243.66
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $81.95 / $81.95 / $86.12	Facility	26	$81.95	$81.95	$86.12
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $180.70 / $183.42 / $309.45	Professional		$180.70	$183.42	$309.45
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.81 / $82.04 / $86.12	Professional	26	$79.81	$82.04	$86.12
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $99.31 / $101.47 / $223.33	Professional	TC	$99.31	$101.47	$223.33
United Facility/Professional Professional Modifier Low / Median / High Price $174.98 / $223.58 / $367.51	Professional		$174.98	$223.58	$367.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.79 / $97.46 / $163.97	Professional	26	$78.79	$97.46	$163.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.17 / $127.43 / $207.51	Professional	TC	$96.17	$127.43	$207.51