Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.00 / $50.22 / $92.64	Facility	26	$42.00	$50.22	$92.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.06 / $173.89 / $545.00	Professional		$104.06	$173.89	$545.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.58 / $66.53 / $181.00	Professional	26	$41.58	$66.53	$181.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.13 / $81.31 / $131.31	Professional	TC	$58.13	$81.31	$131.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.70 / $144.41 / $194.93	Professional		$84.70	$144.41	$194.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.63 / $62.48 / $86.40	Professional	26	$35.63	$62.48	$86.40
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.50 / $102.01 / $115.94	Professional	TC	$75.50	$102.01	$115.94
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $150.51 / $163.13 / $267.38	Professional		$150.51	$163.13	$267.38
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $54.50 / $70.31 / $125.93	Professional	26	$54.50	$70.31	$125.93
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $113.40 / $186.94 / $291.63	Professional		$113.40	$186.94	$291.63
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $46.97 / $76.11 / $116.35	Professional	26	$46.97	$76.11	$116.35
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $66.43 / $109.62 / $175.30	Professional	TC	$66.43	$109.62	$175.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.62 / $154.26 / $240.05	Professional		$94.62	$154.26	$240.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.75 / $60.11 / $94.58	Professional	26	$37.75	$60.11	$94.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.73 / $94.22 / $147.44	Professional	TC	$57.73	$94.22	$147.44
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $135.52 / $160.78 / $345.28	Professional		$135.52	$160.78	$345.28
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.21 / $67.77 / $132.94	Professional	26	$53.21	$67.77	$132.94
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.93 / $106.62 / $212.35	Professional	TC	$82.93	$106.62	$212.35
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.19 / $142.44 / $199.98	Professional		$128.19	$142.44	$199.98
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.04 / $59.39 / $79.63	Professional	26	$51.04	$59.39	$79.63
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.20 / $82.48 / $102.90	Professional	TC	$78.20	$82.48	$102.90
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $132.32 / $161.84 / $267.38	Professional		$132.32	$161.84	$267.38
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $49.43 / $70.31 / $125.93	Professional	26	$49.43	$70.31	$125.93
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $42.00 / $60.06 / $135.58	Facility	26	$42.00	$60.06	$135.58
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $110.11 / $178.90 / $519.00	Professional		$110.11	$178.90	$519.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $70.16 / $168.00	Professional	26	$42.60	$70.16	$168.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $61.59 / $88.99 / $179.71	Professional	TC	$61.59	$88.99	$179.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $49.69 / $108.00 / $210.31	Professional		$49.69	$108.00	$210.31
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $100.77 / $153.56 / $240.05	Professional		$100.77	$153.56	$240.05
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.50 / $60.11 / $94.58	Professional	26	$38.50	$60.11	$94.58
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.57 / $93.89 / $144.77	Professional	TC	$58.57	$93.89	$144.77
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $46.47 / $46.47 / $57.00	Facility	26	$46.47	$46.47	$57.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.61 / $114.13 / $133.00	Professional		$112.61	$114.13	$133.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $45.36 / $46.47 / $57.00	Professional	26	$45.36	$46.47	$57.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $66.19 / $67.65 / $76.00	Professional	TC	$66.19	$67.65	$76.00
United Facility/Professional Professional Modifier Low / Median / High Price $95.18 / $132.76 / $224.89	Professional		$95.18	$132.76	$224.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.15 / $54.32 / $92.51	Professional	26	$39.15	$54.32	$92.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.65 / $79.72 / $130.43	Professional	TC	$58.65	$79.72	$130.43