Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.35 / $47.49 / $116.81	Facility	26	$38.35	$47.49	$116.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $164.03 / $468.00	Professional		$93.43	$164.03	$468.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.33 / $57.10 / $210.00	Professional	26	$35.33	$57.10	$210.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.90 / $69.69 / $128.80	Professional	TC	$55.90	$69.69	$128.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.67 / $102.09 / $161.88	Professional		$78.67	$102.09	$161.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.55 / $56.22 / $74.08	Professional	26	$30.55	$56.22	$74.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $100.05 / $100.05 / $100.05	Professional	TC	$100.05	$100.05	$100.05
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $141.16 / $151.60 / $250.46	Professional		$141.16	$151.60	$250.46
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $52.72 / $64.81 / $101.23	Professional	26	$52.72	$64.81	$101.23
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $111.40 / $174.52 / $207.22	Professional		$111.40	$174.52	$207.22
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.55 / $67.59 / $102.35	Professional	26	$42.55	$67.59	$102.35
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $68.84 / $97.61 / $125.82	Professional	TC	$68.84	$97.61	$125.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.31 / $132.27 / $211.14	Professional		$87.31	$132.27	$211.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.68 / $52.11 / $80.95	Professional	26	$32.68	$52.11	$80.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.72 / $80.23 / $130.36	Professional	TC	$50.72	$80.23	$130.36
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $116.67 / $150.13 / $321.37	Professional		$116.67	$150.13	$321.37
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.53 / $57.78 / $113.09	Professional	26	$45.53	$57.78	$113.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.34 / $104.60 / $208.28	Professional	TC	$81.34	$104.60	$208.28
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $512.50 / $512.50 / $512.50	Facility	26	$512.50	$512.50	$512.50
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.56 / $130.88 / $186.24	Professional		$114.56	$130.88	$186.24
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.06 / $50.34 / $68.73	Professional	26	$44.06	$50.34	$68.73
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.09 / $87.60 / $100.48	Professional	TC	$71.09	$87.60	$100.48
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $141.16 / $151.52 / $238.62	Professional		$141.16	$151.52	$238.62
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $50.69 / $64.81 / $101.23	Professional	26	$50.69	$64.81	$101.23
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $36.53 / $52.97 / $125.71	Facility	26	$36.53	$52.97	$125.71
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $96.67 / $177.24 / $413.47	Professional		$96.67	$177.24	$413.47
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $62.30 / $173.16	Professional	26	$36.61	$62.30	$173.16
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $83.64 / $172.24	Professional	TC	$56.82	$83.64	$172.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.80 / $89.70 / $215.20	Professional		$42.80	$89.70	$215.20
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.25 / $46.25 / $46.25	Facility	26	$46.25	$46.25	$46.25
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $88.31 / $130.34 / $208.04	Professional		$88.31	$130.34	$208.04
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.22 / $52.37 / $80.95	Professional	26	$33.22	$52.37	$80.95
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.14 / $81.01 / $129.37	Professional	TC	$53.14	$81.01	$129.37
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $39.85 / $39.85 / $48.00	Facility	26	$39.85	$39.85	$48.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $104.37 / $105.92 / $114.03	Professional		$104.37	$105.92	$114.03
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.97 / $39.85 / $48.00	Professional	26	$38.97	$39.85	$48.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $60.00 / $66.06 / $72.73	Professional	TC	$60.00	$66.06	$72.73
United Facility/Professional Professional Modifier Low / Median / High Price $84.22 / $120.82 / $202.65	Professional		$84.22	$120.82	$202.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.03 / $46.79 / $78.48	Professional	26	$34.03	$46.79	$78.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.79 / $74.03 / $124.16	Professional	TC	$53.79	$74.03	$124.16