Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.17 / $34.26 / $94.48	Facility	26	$30.17	$34.26	$94.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.72 / $161.35 / $387.00	Professional		$114.72	$161.35	$387.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.74 / $35.70 / $150.00	Professional	26	$27.74	$35.70	$150.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.56 / $99.56 / $187.80	Professional	TC	$70.56	$99.56	$187.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.88 / $208.64 / $234.21	Professional		$144.88	$208.64	$234.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.70 / $27.09 / $48.66	Professional	26	$24.70	$27.09	$48.66
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $119.08 / $175.75 / $308.12	Professional		$119.08	$175.75	$308.12
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $136.49 / $170.59 / $220.67	Professional		$136.49	$170.59	$220.67
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $32.22 / $51.72 / $80.38	Professional	26	$32.22	$51.72	$80.38
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $104.25 / $109.11 / $167.12	Professional	TC	$104.25	$109.11	$167.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.04 / $37.04 / $37.04	Facility	26	$37.04	$37.04	$37.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.54 / $178.24 / $349.77	Professional		$98.54	$178.24	$349.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.06 / $42.26 / $65.16	Professional	26	$26.06	$42.26	$65.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.38 / $135.28 / $292.27	Professional	TC	$68.38	$135.28	$292.27
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $141.62 / $197.74 / $337.50	Professional		$141.62	$197.74	$337.50
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.42 / $46.26 / $72.20	Professional	26	$36.42	$46.26	$72.20
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.06 / $167.22 / $265.30	Professional	TC	$130.06	$167.22	$265.30
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.17 / $235.60 / $300.58	Professional		$123.17	$235.60	$300.58
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.01 / $39.67 / $51.79	Professional	26	$36.01	$39.67	$51.79
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $119.08 / $175.75 / $308.12	Professional		$119.08	$175.75	$308.12
Johns Hopkins Employer Health Plan Facility/Professional Professional Modifier Low / Median / High Price $144.35 / $144.35 / $144.35	Professional		$144.35	$144.35	$144.35
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $29.84 / $41.67 / $99.68	Facility	26	$29.84	$41.67	$99.68
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $181.27 / $370.00	Professional		$118.48	$181.27	$370.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $28.74 / $43.18 / $98.91	Professional	26	$28.74	$43.18	$98.91
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $87.60 / $113.89 / $216.84	Professional	TC	$87.60	$113.89	$216.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.26 / $133.30 / $272.00	Professional		$64.26	$133.30	$272.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $37.04 / $37.04 / $37.04	Facility	26	$37.04	$37.04	$37.04
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $98.54 / $178.77 / $310.14	Professional		$98.54	$178.77	$310.14
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.55 / $42.30 / $64.80	Professional	26	$26.55	$42.30	$64.80
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.38 / $135.28 / $262.68	Professional	TC	$68.38	$135.28	$262.68
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $31.58 / $31.58 / $37.58	Facility	26	$31.58	$31.58	$37.58
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $128.91 / $132.44 / $142.31	Professional		$128.91	$132.44	$142.31
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.86 / $31.58 / $37.58	Professional	26	$30.86	$31.58	$37.58
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $95.46 / $99.58 / $109.63	Professional	TC	$95.46	$99.58	$109.63
United Facility/Professional Professional Modifier Low / Median / High Price $100.11 / $161.87 / $283.52	Professional		$100.11	$161.87	$283.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.64 / $36.08 / $61.81	Professional	26	$28.64	$36.08	$61.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.38 / $131.77 / $220.40	Professional	TC	$78.38	$131.77	$220.40