Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $63.10 / $114.82	Facility	26	$28.18	$63.10	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $100.00 / $354.81	Professional		$51.29	$100.00	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $50.12 / $128.82	Professional	26	$24.55	$50.12	$128.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $60.26 / $138.04 / $724.44	Professional	50	$60.26	$138.04	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $28.18 / $128.82	Professional	TC	$10.96	$28.18	$128.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $43.65 / $91.20	Professional		$35.48	$43.65	$91.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $40.74 / $83.18	Professional	26	$23.99	$40.74	$83.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $8.13 / $8.13 / $8.91	Professional	TC	$8.13	$8.13	$8.91
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $69.18 / $234.42	Professional		$53.70	$69.18	$234.42
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $44.67 / $72.44	Professional	26	$42.66	$44.67	$72.44
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $13.80 / $173.78	Professional	TC	$10.23	$13.80	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $69.18	Facility	26	$10.47	$48.98	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $117.49 / $194.98	Professional		$51.29	$117.49	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $40.74 / $66.07	Professional	26	$26.30	$40.74	$66.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $83.18 / $144.54	Professional	TC	$10.47	$83.18	$144.54
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $72.44 / $89.13	Professional		$63.10	$72.44	$89.13
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $69.18	Professional	26	$37.15	$57.54	$69.18
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.77 / $15.14 / $19.50	Professional	TC	$9.77	$15.14	$19.50
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $89.13 / $154.88	Professional		$57.54	$89.13	$154.88
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $45.71 / $72.44	Professional	26	$23.99	$45.71	$72.44
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $22.39 / $102.33	Professional	TC	$11.22	$22.39	$102.33
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $66.07 / $87.10	Professional		$60.26	$66.07	$87.10
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $56.23 / $89.13	Professional	26	$47.86	$56.23	$89.13
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $63.10 / $67.61 / $70.79	Professional	50	$63.10	$67.61	$70.79
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $63.10 / $114.82	Facility	26	$28.18	$63.10	$114.82
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $97.72 / $269.15	Professional		$51.29	$97.72	$269.15
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $47.86 / $100.00	Professional	26	$25.12	$47.86	$100.00
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $60.26 / $138.04 / $724.44	Professional	50	$60.26	$138.04	$724.44
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $30.20 / $138.04	Professional	TC	$12.30	$30.20	$138.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $107.15 / $234.42	Professional		$45.71	$107.15	$234.42
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $81.28	Facility	26	$42.66	$42.66	$81.28
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $12.59 / $52.48 / $104.71	Professional		$12.59	$52.48	$104.71
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $42.66 / $81.28	Professional	26	$30.20	$42.66	$81.28
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $10.72 / $77.62	Professional	TC	$10.23	$10.72	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $91.20 / $165.96	Professional		$60.26	$91.20	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.88 / $56.23	Professional	26	$25.70	$33.88	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $52.48 / $117.49	Professional	TC	$15.14	$52.48	$117.49