Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.91 / $30.80 / $52.68	Facility	26	$26.91	$30.80	$52.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.41 / $106.50 / $200.88	Professional		$86.41	$106.50	$200.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.55 / $28.03 / $67.15	Professional	26	$23.55	$28.03	$67.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.22 / $74.95 / $117.70	Professional	TC	$62.22	$74.95	$117.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.34 / $81.01 / $156.97	Professional		$78.34	$81.01	$156.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.13 / $22.83 / $45.63	Professional	26	$21.13	$22.83	$45.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $114.70 / $114.70 / $114.70	Professional	TC	$114.70	$114.70	$114.70
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $31.94 / $146.86 / $230.07	Professional	26	$31.94	$146.86	$230.07
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $102.23 / $144.90 / $194.14	Professional		$102.23	$144.90	$194.14
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $28.49 / $40.72 / $56.26	Professional	26	$28.49	$40.72	$56.26
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $73.73 / $104.18 / $137.85	Professional	TC	$73.73	$104.18	$137.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.16 / $132.47 / $201.22	Professional		$82.16	$132.47	$201.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.85 / $37.32 / $57.23	Professional	26	$22.85	$37.32	$57.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.06 / $95.98 / $147.18	Professional	TC	$60.06	$95.98	$147.18
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $118.96 / $147.36 / $252.97	Professional		$118.96	$147.36	$252.97
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.32 / $64.70	Professional	26	$32.36	$41.32	$64.70
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.21 / $118.56 / $188.26	Professional	TC	$92.21	$118.56	$188.26
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.09 / $125.63 / $132.46	Professional		$122.09	$125.63	$132.46
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.51 / $35.15 / $49.76	Professional	26	$31.51	$35.15	$49.76
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.90 / $134.01 / $137.47	Professional	TC	$85.90	$134.01	$137.47
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $28.52 / $139.34 / $230.07	Professional	26	$28.52	$139.34	$230.07
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $25.63 / $37.15 / $88.48	Facility	26	$25.63	$37.15	$88.48
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $91.54 / $119.50 / $247.64	Professional		$91.54	$119.50	$247.64
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $25.47 / $31.68 / $66.40	Professional	26	$25.47	$31.68	$66.40
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $65.33 / $81.92 / $166.49	Professional	TC	$65.33	$81.92	$166.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $120.60 / $120.60 / $284.39	Professional		$120.60	$120.60	$284.39
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $83.31 / $130.59 / $201.22	Professional		$83.31	$130.59	$201.22
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $37.32 / $57.23	Professional	26	$23.25	$37.32	$57.23
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.21 / $94.92 / $144.15	Professional	TC	$62.21	$94.92	$144.15
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $28.18 / $33.19	Facility	26	$28.18	$28.18	$33.19
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $98.75 / $100.25 / $114.49	Professional		$98.75	$100.25	$114.49
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $28.23 / $33.19	Professional	26	$27.41	$28.23	$33.19
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $70.51 / $72.08 / $81.30	Professional	TC	$70.51	$72.08	$81.30
United Facility/Professional Professional Modifier Low / Median / High Price $86.49 / $118.80 / $215.38	Professional		$86.49	$118.80	$215.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.14 / $32.75 / $58.78	Professional	26	$24.14	$32.75	$58.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.60 / $85.75 / $137.28	Professional	TC	$62.60	$85.75	$137.28