Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $72.81 / $917.85 / $1,320.96	Facility		$72.81	$917.85	$1,320.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.58 / $38.92 / $96.63	Facility	26	$28.58	$38.92	$96.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.92 / $100.03 / $366.59	Professional		$50.92	$100.03	$366.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.55 / $33.29 / $124.46	Professional	26	$26.55	$33.29	$124.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.11 / $35.72 / $187.42	Professional	TC	$22.11	$35.72	$187.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $39.19 / $46.54 / $106.57	Professional		$39.19	$46.54	$106.57
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $32.63 / $57.14	Professional	26	$22.85	$32.63	$57.14
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $2,447.39 / $5,031.00 / $6,579.00	Facility		$2,447.39	$5,031.00	$6,579.00
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $72.04 / $74.22 / $126.30	Professional		$72.04	$74.22	$126.30
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $33.77 / $45.19 / $73.30	Professional	26	$33.77	$45.19	$73.30
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $8,639.91 / $79,506.39	Facility		$5,000.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $68.86 / $71.04 / $71.04	Professional		$68.86	$71.04	$71.04
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $50.81 / $77.55	Professional	26	$36.00	$50.81	$77.55
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $32.86 / $42.05 / $231.12	Professional	TC	$32.86	$42.05	$231.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $65.84 / $65.84 / $303.75	Facility		$65.84	$65.84	$303.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.51 / $34.51 / $34.51	Facility	26	$34.51	$34.51	$34.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.98 / $107.89 / $253.49	Professional		$50.98	$107.89	$253.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.50 / $40.18 / $62.98	Professional	26	$24.50	$40.18	$62.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.08 / $49.20 / $208.94	Professional	TC	$23.08	$49.20	$208.94
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $68.45 / $90.31 / $199.72	Professional		$68.45	$90.31	$199.72
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.17 / $43.51 / $68.02	Professional	26	$34.17	$43.51	$68.02
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.61 / $44.51 / $70.72	Professional	TC	$34.61	$44.51	$70.72
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $126.11 / $360.66 / $1,011.00	Facility		$126.11	$360.66	$1,011.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.45 / $70.90 / $85.43	Professional		$64.45	$70.90	$85.43
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.68 / $36.44 / $49.55	Professional	26	$32.68	$36.44	$49.55
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $2,447.39 / $3,846.78 / $6,579.00	Facility		$2,447.39	$3,846.78	$6,579.00
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $59.82 / $74.22 / $129.02	Professional		$59.82	$74.22	$129.02
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $30.15 / $37.65 / $62.70	Professional	26	$30.15	$37.65	$62.70
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $66.19 / $521.07 / $1,643.20	Facility		$66.19	$521.07	$1,643.20
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $28.58 / $43.14 / $96.63	Facility	26	$28.58	$43.14	$96.63
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $50.92 / $93.82 / $348.99	Professional		$50.92	$93.82	$348.99
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $27.22 / $39.63 / $87.79	Professional	26	$27.22	$39.63	$87.79
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $23.69 / $39.39 / $187.42	Professional	TC	$23.69	$39.39	$187.42
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $11,203.73 / $11,821.68 / $18,544.05	Facility		$11,203.73	$11,821.68	$18,544.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.06 / $116.20 / $390.20	Professional		$37.06	$116.20	$390.20
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $65.84 / $65.84 / $303.75	Facility		$65.84	$65.84	$303.75
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.51 / $34.51 / $34.51	Facility	26	$34.51	$34.51	$34.51
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $53.59 / $102.81 / $250.20	Professional		$53.59	$102.81	$250.20
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.73 / $40.18 / $61.58	Professional	26	$24.73	$40.18	$61.58
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.95 / $47.28 / $208.94	Professional	TC	$23.95	$47.28	$208.94
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $56.49 / $56.49 / $181.32	Facility		$56.49	$56.49	$181.32
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $29.94 / $29.94 / $42.00	Facility	26	$29.94	$29.94	$42.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $55.48 / $56.49 / $181.32	Professional		$55.48	$56.49	$181.32
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $30.02 / $42.00	Professional	26	$29.11	$30.02	$42.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $26.55 / $139.32	Professional	TC	$26.01	$26.55	$139.32
United Facility/Professional Professional Modifier Low / Median / High Price $50.71 / $73.23 / $203.89	Professional		$50.71	$73.23	$203.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.94 / $35.47 / $58.89	Professional	26	$26.94	$35.47	$58.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.41 / $33.79 / $170.12	Professional	TC	$22.41	$33.79	$170.12