Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.58 / $38.45 / $66.81	Facility	26	$29.58	$38.45	$66.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.62 / $175.23 / $396.00	Professional		$105.62	$175.23	$396.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.58 / $50.35 / $127.88	Professional	26	$29.58	$50.35	$127.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $47.66 / $55.41 / $260.25	Professional	52	$47.66	$55.41	$260.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.77 / $96.12 / $219.00	Professional	TC	$71.77	$96.12	$219.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.86 / $95.92 / $174.93	Professional		$78.86	$95.92	$174.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.60 / $33.97 / $54.20	Professional	26	$24.60	$33.97	$54.20
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $17.52 / $21.90 / $21.90	Professional	52	$17.52	$21.90	$21.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $124.45 / $141.51	Professional	TC	$69.56	$124.45	$141.51
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $153.35 / $166.32 / $274.77	Professional		$153.35	$166.32	$274.77
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $34.61 / $47.01 / $79.16	Professional	26	$34.61	$47.01	$79.16
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $113.92 / $118.22 / $207.82	Professional		$113.92	$118.22	$207.82
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $34.11 / $55.18 / $80.64	Professional	26	$34.11	$55.18	$80.64
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $81.05 / $127.20 / $157.91	Professional	TC	$81.05	$127.20	$157.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.50 / $140.43 / $228.64	Professional		$94.50	$140.43	$228.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.36 / $41.87 / $65.59	Professional	26	$26.36	$41.87	$65.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.98 / $100.22 / $162.78	Professional	TC	$64.98	$100.22	$162.78
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $125.66 / $163.99 / $281.13	Professional		$125.66	$163.99	$281.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $47.49 / $74.30	Professional	26	$37.27	$47.49	$74.30
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.31 / $130.26 / $206.84	Professional	TC	$101.31	$130.26	$206.84
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.19 / $145.13 / $183.25	Professional		$134.19	$145.13	$183.25
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.38 / $42.99 / $58.11	Professional	26	$36.38	$42.99	$58.11
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $20.01 / $67.15 / $73.86	Professional	52	$20.01	$67.15	$73.86
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.49 / $107.69 / $151.91	Professional	TC	$96.49	$107.69	$151.91
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $132.19 / $170.19 / $274.77	Professional		$132.19	$170.19	$274.77
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $32.85 / $44.62 / $79.16	Professional	26	$32.85	$44.62	$79.16
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $189.29 / $189.29 / $189.29	Professional		$189.29	$189.29	$189.29
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $29.58 / $42.23 / $92.63	Facility	26	$29.58	$42.23	$92.63
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $108.01 / $177.54 / $369.75	Professional		$108.01	$177.54	$369.75
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $50.60 / $105.00	Professional	26	$29.75	$50.60	$105.00
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $49.85 / $60.99 / $260.25	Professional	52	$49.85	$60.99	$260.25
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $75.98 / $104.09 / $237.55	Professional	TC	$75.98	$104.09	$237.55
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.89 / $117.60 / $217.40	Professional		$45.89	$117.60	$217.40
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $37.42 / $37.42	Facility	26	$37.42	$37.42	$37.42
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $94.76 / $140.28 / $223.02	Professional		$94.76	$140.28	$223.02
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.87 / $41.72 / $65.59	Professional	26	$26.87	$41.72	$65.59
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.97 / $100.72 / $161.88	Professional	TC	$65.97	$100.72	$161.88
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $32.83 / $32.83 / $42.75	Facility	26	$32.83	$32.83	$42.75
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $113.88 / $115.66 / $125.25	Professional		$113.88	$115.66	$125.25
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $32.86 / $42.75	Professional	26	$31.98	$32.86	$42.75
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $82.83 / $91.18	Professional	TC	$81.02	$82.83	$91.18
United Facility/Professional Professional Modifier Low / Median / High Price $90.42 / $129.28 / $231.84	Professional		$90.42	$129.28	$231.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.78 / $38.20 / $65.04	Professional	26	$27.78	$38.20	$65.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.37 / $96.05 / $160.10	Professional	TC	$67.37	$96.05	$160.10