Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.43 / $116.75 / $210.15	Facility	26	$102.43	$116.75	$210.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $317.62 / $475.00 / $2,105.00	Professional		$317.62	$475.00	$2,105.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $140.00 / $389.19	Professional	26	$93.73	$140.00	$389.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $207.69 / $259.62 / $435.50	Professional	TC	$207.69	$259.62	$435.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $226.60 / $266.91 / $349.19	Professional		$226.60	$266.91	$349.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $84.64 / $144.41 / $180.51	Professional	26	$84.64	$144.41	$180.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $353.31 / $353.31 / $353.31	Professional	TC	$353.31	$353.31	$353.31
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $390.61 / $442.17 / $2,862.80	Professional		$390.61	$442.17	$2,862.80
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $126.90 / $442.17 / $925.54	Professional	26	$126.90	$442.17	$925.54
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $336.62 / $487.55 / $727.47	Professional		$336.62	$487.55	$727.47
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $109.36 / $144.66 / $215.86	Professional	26	$109.36	$144.66	$215.86
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $227.25 / $342.90 / $526.57	Professional	TC	$227.25	$342.90	$526.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $283.64 / $471.49 / $753.98	Professional		$283.64	$471.49	$753.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.73 / $133.53 / $215.32	Professional	26	$78.73	$133.53	$215.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.92 / $327.10 / $528.57	Professional	TC	$204.92	$327.10	$528.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $405.68 / $521.51 / $869.35	Professional		$405.68	$521.51	$869.35
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.90 / $149.28 / $660.81	Professional	26	$119.90	$149.28	$660.81
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $271.95 / $338.65 / $482.39	Professional	TC	$271.95	$338.65	$482.39
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $388.90 / $427.80 / $565.45	Professional		$388.90	$427.80	$565.45
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.61 / $128.58 / $183.81	Professional	26	$114.61	$128.58	$183.81
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $357.92 / $357.92 / $429.50	Professional	TC	$357.92	$357.92	$429.50
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $385.88 / $419.53 / $2,862.80	Professional		$385.88	$419.53	$2,862.80
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $114.96 / $419.53 / $925.54	Professional	26	$114.96	$419.53	$925.54
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $102.43 / $155.78 / $335.40	Facility	26	$102.43	$155.78	$335.40
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $318.02 / $475.00 / $1,964.80	Professional		$318.02	$475.00	$1,964.80
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $97.56 / $144.43 / $347.00	Professional	26	$97.56	$144.43	$347.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $220.06 / $298.00 / $663.78	Professional	TC	$220.06	$298.00	$663.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $155.18 / $421.74 / $635.14	Professional		$155.18	$421.74	$635.14
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $124.62 / $124.62 / $124.62	Facility	26	$124.62	$124.62	$124.62
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $298.57 / $476.82 / $753.98	Professional		$298.57	$476.82	$753.98
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.76 / $133.03 / $222.14	Professional	26	$78.76	$133.03	$222.14
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $204.92 / $327.10 / $528.57	Professional	TC	$204.92	$327.10	$528.57
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $107.87 / $107.87 / $127.30	Facility	26	$107.87	$107.87	$127.30
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $340.22 / $345.27 / $429.04	Professional		$340.22	$345.27	$429.04
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $105.11 / $107.91 / $127.30	Professional	26	$105.11	$107.91	$127.30
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $232.30 / $237.41 / $301.75	Professional	TC	$232.30	$237.41	$301.75
United Facility/Professional Professional Modifier Low / Median / High Price $345.37 / $559.20 / $1,084.44	Professional		$345.37	$559.20	$1,084.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.42 / $117.65 / $213.01	Professional	26	$80.42	$117.65	$213.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $241.36 / $362.04 / $874.20	Professional	TC	$241.36	$362.04	$874.20