Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.40 / $54.97 / $93.31	Facility	26	$44.40	$54.97	$93.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.91 / $195.07 / $583.00	Professional		$118.91	$195.07	$583.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $64.66 / $190.78	Professional	26	$40.90	$64.66	$190.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.31 / $97.71 / $169.09	Professional	TC	$72.31	$97.71	$169.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.24 / $126.56 / $200.00	Professional		$97.24	$126.56	$200.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $57.99 / $77.98	Professional	26	$35.65	$57.99	$77.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $94.56 / $127.38 / $127.38	Professional	TC	$94.56	$127.38	$127.38
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $175.98 / $188.50 / $308.52	Professional		$175.98	$188.50	$308.52
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $58.60 / $77.30 / $107.28	Professional	26	$58.60	$77.30	$107.28
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $130.24 / $214.89 / $291.63	Professional		$130.24	$214.89	$291.63
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $47.29 / $76.64 / $116.35	Professional	26	$47.29	$76.64	$116.35
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $82.96 / $136.49 / $175.30	Professional	TC	$82.96	$136.49	$175.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.79 / $168.62 / $266.55	Professional		$108.79	$168.62	$266.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $60.11 / $93.82	Professional	26	$38.01	$60.11	$93.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.03 / $109.98 / $173.66	Professional	TC	$70.03	$109.98	$173.66
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $149.11 / $185.84 / $399.59	Professional		$149.11	$185.84	$399.59
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.60 / $68.28 / $133.97	Professional	26	$53.60	$68.28	$133.97
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.70 / $133.33 / $265.62	Professional	TC	$103.70	$133.33	$265.62
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.05 / $159.83 / $204.26	Professional		$144.05	$159.83	$204.26
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.41 / $57.38 / $77.66	Professional	26	$51.41	$57.38	$77.66
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.74 / $111.90 / $128.01	Professional	TC	$86.74	$111.90	$128.01
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $174.23 / $185.44 / $305.43	Professional		$174.23	$185.44	$305.43
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $58.60 / $77.30 / $107.28	Professional	26	$58.60	$77.30	$107.28
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $42.29 / $61.32 / $136.59	Facility	26	$42.29	$61.32	$136.59
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $123.13 / $201.80 / $441.37	Professional		$123.13	$201.80	$441.37
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $42.29 / $67.59 / $167.81	Professional	26	$42.29	$67.59	$167.81
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $75.93 / $106.34 / $208.87	Professional	TC	$75.93	$106.34	$208.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $51.33 / $138.88 / $272.48	Professional		$51.33	$138.88	$272.48
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $53.96 / $53.96 / $53.96	Facility	26	$53.96	$53.96	$53.96
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $109.95 / $165.88 / $261.19	Professional		$109.95	$165.88	$261.19
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.76 / $60.11 / $93.82	Professional	26	$38.76	$60.11	$93.82
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.43 / $109.94 / $169.76	Professional	TC	$76.43	$109.94	$169.76
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $46.79 / $46.79 / $54.00	Facility	26	$46.79	$46.79	$54.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $129.35 / $131.19 / $144.93	Professional		$129.35	$131.19	$144.93
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $45.67 / $46.79 / $54.00	Professional	26	$45.67	$46.79	$54.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $82.62 / $84.40 / $92.92	Professional	TC	$82.62	$84.40	$92.92
United Facility/Professional Professional Modifier Low / Median / High Price $110.42 / $152.22 / $254.44	Professional		$110.42	$152.22	$254.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $53.99 / $92.12	Professional	26	$39.97	$53.99	$92.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.53 / $99.72 / $169.60	Professional	TC	$71.53	$99.72	$169.60