Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.23 / $37.11 / $79.38	Facility	26	$28.23	$37.11	$79.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.57 / $97.92 / $312.00	Professional		$48.57	$97.92	$312.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $34.51 / $93.35	Professional	26	$24.78	$34.51	$93.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $37.04 / $129.54	Professional	TC	$10.96	$37.04	$129.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.88 / $41.00 / $46.32	Professional		$35.88	$41.00	$46.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.90 / $67.06 / $81.00	Professional	26	$31.90	$67.06	$81.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $7.82 / $7.82 / $7.82	Professional	TC	$7.82	$7.82	$7.82
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $60.31 / $99.48 / $274.64	Professional		$60.31	$99.48	$274.64
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $53.11 / $90.98 / $233.27	Professional		$53.11	$90.98	$233.27
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.93 / $50.38 / $73.12	Professional	26	$42.93	$50.38	$73.12
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $10.17 / $17.86 / $173.17	Professional	TC	$10.17	$17.86	$173.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.60 / $122.39 / $206.97	Professional		$52.60	$122.39	$206.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.26 / $41.07 / $70.81	Professional	26	$27.26	$41.07	$70.81
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.21 / $115.21 / $131.31	Professional	50	$115.21	$115.21	$131.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.55 / $79.75 / $148.65	Professional	TC	$10.55	$79.75	$148.65
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $61.34 / $80.33 / $132.99	Professional		$61.34	$80.33	$132.99
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.69 / $62.06 / $97.07	Professional	26	$48.69	$62.06	$97.07
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.84 / $16.51 / $26.31	Professional	TC	$12.84	$16.51	$26.31
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.36 / $66.64 / $94.81	Professional		$62.36	$66.64	$94.81
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $45.39 / $68.33 / $88.91	Professional	26	$45.39	$68.33	$88.91
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $62.80 / $66.43 / $66.84	Professional	50	$62.80	$66.43	$66.84
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $53.85 / $85.41 / $219.16	Professional		$53.85	$85.41	$219.16
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $26.89 / $38.99 / $92.34	Facility	26	$26.89	$38.99	$92.34
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $51.46 / $97.92 / $304.77	Professional		$51.46	$97.92	$304.77
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $25.38 / $44.35 / $90.20	Professional	26	$25.38	$44.35	$90.20
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $12.85 / $37.04 / $138.78	Professional	TC	$12.85	$37.04	$138.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.19 / $98.22 / $140.50	Professional		$16.19	$98.22	$140.50
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $53.85 / $121.82 / $201.90	Professional		$53.85	$121.82	$201.90
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.51 / $68.73	Professional	26	$28.18	$41.51	$68.73
Priority Health Facility/Professional Professional Modifier 50 Low / Median / High Price $115.21 / $131.31 / $131.31	Professional	50	$115.21	$131.31	$131.31
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.73 / $79.30 / $147.52	Professional	TC	$10.73	$79.30	$147.52
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.48 / $42.48 / $82.00	Facility	26	$42.48	$42.48	$82.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $40.36 / $52.90 / $55.54	Professional		$40.36	$52.90	$55.54
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.25 / $42.48 / $82.00	Professional	26	$30.25	$42.48	$82.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $10.25 / $10.63 / $76.93	Professional	TC	$10.25	$10.63	$76.93
United Facility/Professional Professional Modifier Low / Median / High Price $61.52 / $91.98 / $172.46	Professional		$61.52	$91.98	$172.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.24 / $36.06 / $62.29	Professional	26	$25.24	$36.06	$62.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.77 / $57.14 / $114.47	Professional	TC	$30.77	$57.14	$114.47