Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.80 / $231.00 / $1,304.23	Facility		$41.80	$231.00	$1,304.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.78 / $42.74 / $103.33	Facility	26	$26.78	$42.74	$103.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.80 / $82.40 / $174.25	Professional		$41.80	$82.40	$174.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.27 / $45.34 / $107.88	Professional	26	$25.27	$45.34	$107.88
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.51 / $180.44 / $465.25	Professional	50	$94.51	$180.44	$465.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.18 / $30.46 / $60.50	Professional	TC	$14.18	$30.46	$60.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.08 / $46.08 / $46.08	Professional	26	$46.08	$46.08	$46.08
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $60.87 / $60.87 / $60.87	Professional		$60.87	$60.87	$60.87
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $8,639.91 / $79,506.39	Facility		$5,000.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $46.85 / $76.11 / $203.89	Professional		$46.85	$76.11	$203.89
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $30.01 / $48.68 / $116.64	Professional	26	$30.01	$48.68	$116.64
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $93.70 / $152.24 / $407.78	Professional	50	$93.70	$152.24	$407.78
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $16.84 / $29.23 / $115.15	Professional	TC	$16.84	$29.23	$115.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $31.13 / $60.59 / $342.91	Facility		$31.13	$60.59	$342.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.35 / $95.33 / $165.24	Professional		$44.35	$95.33	$165.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.67 / $52.26 / $85.32	Professional	26	$26.67	$52.26	$85.32
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $79.23 / $79.23 / $90.51	Professional	50	$79.23	$79.23	$90.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.69 / $40.56 / $96.05	Professional	TC	$16.69	$40.56	$96.05
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $55.20 / $72.47 / $111.32	Professional		$55.20	$72.47	$111.32
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.28 / $43.56 / $68.06	Professional	26	$34.28	$43.56	$68.06
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.16 / $27.20 / $43.26	Professional	TC	$21.16	$27.20	$43.26
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $150.28 / $331.79 / $605.30	Facility		$150.28	$331.79	$605.30
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $31.91 / $34.19	Professional	26	$31.66	$31.91	$34.19
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $60.87 / $60.87 / $60.87	Professional		$60.87	$60.87	$60.87
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $51.80 / $168.73 / $363.47	Facility		$51.80	$168.73	$363.47
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $29.31 / $44.87 / $115.77	Facility	26	$29.31	$44.87	$115.77
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $44.71 / $89.29 / $200.00	Professional		$44.71	$89.29	$200.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $47.77 / $118.49	Professional	26	$26.78	$47.77	$118.49
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $94.51 / $180.44 / $465.25	Professional	50	$94.51	$180.44	$465.25
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $15.02 / $31.14 / $64.75	Professional	TC	$15.02	$31.14	$64.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $106.30 / $118.40 / $200.00	Professional		$106.30	$118.40	$200.00
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $31.13 / $60.59 / $342.91	Facility		$31.13	$60.59	$342.91
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $34.29	Facility	26	$34.29	$34.29	$34.29
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $46.17 / $93.42 / $163.46	Professional		$46.17	$93.42	$163.46
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.31 / $51.27 / $84.39	Professional	26	$28.31	$51.27	$84.39
Priority Health Facility/Professional Professional Modifier 50 Low / Median / High Price $79.23 / $90.51 / $90.51	Professional	50	$79.23	$90.51	$90.51
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.25 / $39.14 / $81.27	Professional	TC	$17.25	$39.14	$81.27
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $46.47 / $46.47 / $127.82	Facility		$46.47	$46.47	$127.82
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $29.72 / $29.72 / $50.00	Facility	26	$29.72	$29.72	$50.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $45.76 / $46.47 / $127.82	Professional		$45.76	$46.47	$127.82
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $29.15 / $29.72 / $50.00	Professional	26	$29.15	$29.72	$50.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $16.43 / $16.75 / $77.81	Professional	TC	$16.43	$16.75	$77.81
United Facility/Professional Professional Modifier Low / Median / High Price $43.93 / $69.56 / $125.53	Professional		$43.93	$69.56	$125.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.93 / $38.07 / $65.36	Professional	26	$26.93	$38.07	$65.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.32 / $25.78 / $59.40	Professional	TC	$17.32	$25.78	$59.40