Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.77 / $135.91 / $303.33	Facility	26	$109.77	$135.91	$303.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $349.25 / $475.00 / $2,270.38	Professional		$349.25	$475.00	$2,270.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.17 / $154.00 / $444.62	Professional	26	$101.17	$154.00	$444.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $244.56 / $299.00 / $828.53	Professional	TC	$244.56	$299.00	$828.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.97 / $255.52 / $293.43	Professional		$229.97	$255.52	$293.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $137.91 / $172.18	Professional	26	$80.70	$137.91	$172.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $211.65 / $354.29 / $354.29	Professional	TC	$211.65	$354.29	$354.29
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $385.52 / $521.88 / $5,955.87	Professional		$385.52	$521.88	$5,955.87
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $121.08 / $155.22 / $3,049.33	Professional	26	$121.08	$155.22	$3,049.33
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $363.58 / $574.00 / $1,757.90	Professional		$363.58	$574.00	$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 $249.39 / $397.90 / $1,558.03	Professional	TC	$249.39	$397.90	$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 $329.10 / $721.91 / $1,360.31	Professional		$329.10	$721.91	$1,360.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.11 / $129.34 / $209.27	Professional	26	$75.11	$129.34	$209.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $235.29 / $574.05 / $1,163.33	Professional	TC	$235.29	$574.05	$1,163.33
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $400.72 / $531.95 / $2,224.96	Professional		$400.72	$531.95	$2,224.96
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 $272.70 / $339.60 / $483.76	Professional	TC	$272.70	$339.60	$483.76
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.04 / $397.78 / $869.93	Professional		$363.04	$397.78	$869.93
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.53 / $126.46 / $181.61	Professional	26	$115.53	$126.46	$181.61
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $275.70 / $424.85 / $430.10	Professional	TC	$275.70	$424.85	$430.10
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $348.68 / $500.00 / $1,982.28	Professional		$348.68	$500.00	$1,982.28
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $104.35 / $140.47 / $1,044.99	Professional	26	$104.35	$140.47	$1,044.99
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $104.55 / $148.63 / $398.16	Facility	26	$104.55	$148.63	$398.16
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $352.10 / $475.00 / $1,754.00	Professional		$352.10	$475.00	$1,754.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $102.26 / $151.19 / $348.00	Professional	26	$102.26	$151.19	$348.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $247.54 / $324.63 / $783.89	Professional	TC	$247.54	$324.63	$783.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.80 / $322.49 / $700.00	Professional		$110.80	$322.49	$700.00
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 $336.15 / $658.01 / $1,337.29	Professional		$336.15	$658.01	$1,337.29
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.08 / $127.97 / $209.27	Professional	26	$78.08	$127.97	$209.27
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $236.49 / $527.49 / $1,138.40	Professional	TC	$236.49	$527.49	$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 $335.23 / $340.31 / $1,046.70	Professional		$335.23	$340.31	$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 $232.30 / $237.41 / $927.00	Professional	TC	$232.30	$237.41	$927.00
United Facility/Professional Professional Modifier Low / Median / High Price $339.67 / $501.02 / $1,023.35	Professional		$339.67	$501.02	$1,023.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.62 / $121.98 / $203.17	Professional	26	$95.62	$121.98	$203.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $240.75 / $347.75 / $838.28	Professional	TC	$240.75	$347.75	$838.28