Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.15 / $39.65 / $119.57	Facility	26	$29.15	$39.65	$119.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.15 / $126.29 / $399.66	Professional		$72.15	$126.29	$399.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.64 / $47.17 / $129.00	Professional	26	$27.64	$47.17	$129.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.48 / $61.17 / $121.40	Professional	TC	$41.48	$61.17	$121.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $58.19 / $96.33 / $135.27	Professional		$58.19	$96.33	$135.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $38.02 / $50.90	Professional	26	$23.28	$38.02	$50.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.14 / $73.20 / $73.20	Professional	TC	$53.14	$73.20	$73.20
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $105.98 / $112.47 / $214.53	Professional		$105.98	$112.47	$214.53
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $39.01 / $43.40 / $75.23	Professional	26	$39.01	$43.40	$75.23
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $78.55 / $129.22 / $195.47	Professional		$78.55	$129.22	$195.47
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $50.52 / $77.55	Professional	26	$30.87	$50.52	$77.55
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $47.68 / $77.92 / $117.88	Professional	TC	$47.68	$77.92	$117.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.11 / $106.48 / $166.65	Professional		$65.11	$106.48	$166.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.75 / $39.31 / $61.41	Professional	26	$24.75	$39.31	$61.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.75 / $67.70 / $105.24	Professional	TC	$40.75	$67.70	$105.24
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $94.08 / $111.61 / $240.17	Professional		$94.08	$111.61	$240.17
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.99 / $44.62 / $87.59	Professional	26	$34.99	$44.62	$87.59
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.57 / $76.59 / $152.55	Professional	TC	$59.57	$76.59	$152.55
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.23 / $102.67 / $139.19	Professional		$89.23	$102.67	$139.19
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.42 / $37.90 / $52.72	Professional	26	$33.42	$37.90	$52.72
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.30 / $55.81 / $85.96	Professional	TC	$55.30	$55.81	$85.96
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $105.98 / $118.70 / $197.30	Professional		$105.98	$118.70	$197.30
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $39.01 / $41.77 / $68.39	Professional	26	$39.01	$41.77	$68.39
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $27.77 / $40.27 / $98.98	Facility	26	$27.77	$40.27	$98.98
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $77.87 / $128.01 / $363.00	Professional		$77.87	$128.01	$363.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $27.77 / $48.14 / $115.62	Professional	26	$27.77	$48.14	$115.62
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $43.93 / $64.87 / $135.79	Professional	TC	$43.93	$64.87	$135.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $32.77 / $83.40 / $169.10	Professional		$32.77	$83.40	$169.10
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $35.11 / $35.11 / $35.11	Facility	26	$35.11	$35.11	$35.11
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $66.79 / $105.79 / $166.65	Professional		$66.79	$105.79	$166.65
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.21 / $39.31 / $61.41	Professional	26	$25.21	$39.31	$61.41
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.10 / $66.93 / $105.24	Professional	TC	$44.10	$66.93	$105.24
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $30.84 / $30.84 / $35.50	Facility	26	$30.84	$30.84	$35.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $77.80 / $78.89 / $116.00	Professional		$77.80	$78.89	$116.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.02 / $30.88 / $35.50	Professional	26	$30.02	$30.88	$35.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $47.03 / $48.05 / $80.50	Professional	TC	$47.03	$48.05	$80.50
United Facility/Professional Professional Modifier Low / Median / High Price $68.90 / $91.39 / $153.28	Professional		$68.90	$91.39	$153.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.09 / $34.72 / $60.07	Professional	26	$26.09	$34.72	$60.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.86 / $57.56 / $96.29	Professional	TC	$41.86	$57.56	$96.29