Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.72 / $42.54 / $74.61	Facility	26	$35.72	$42.54	$74.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.00 / $139.07 / $589.00	Professional		$103.00	$139.07	$589.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $38.57 / $84.70	Professional	26	$32.86	$38.57	$84.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.62 / $13.62 / $13.62	Professional	52	$13.62	$13.62	$13.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.59 / $93.23 / $231.78	Professional	TC	$74.59	$93.23	$231.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $86.28 / $96.61 / $126.35	Professional		$86.28	$96.61	$126.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.53 / $39.70 / $63.08	Professional	26	$29.53	$39.70	$63.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $64.31 / $64.31 / $71.73	Professional	TC	$64.31	$64.31	$71.73
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $38.22 / $42.30 / $69.88	Professional	26	$38.22	$42.30	$69.88
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $121.85 / $197.66 / $242.37	Professional		$121.85	$197.66	$242.37
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $62.00 / $74.34	Professional	26	$38.26	$62.00	$74.34
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $83.59 / $135.66 / $173.05	Professional	TC	$83.59	$135.66	$173.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.71 / $158.10 / $249.28	Professional		$97.71	$158.10	$249.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.71 / $47.44 / $76.01	Professional	26	$27.71	$47.44	$76.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.33 / $111.57 / $172.33	Professional	TC	$68.33	$111.57	$172.33
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $141.97 / $174.78 / $299.89	Professional		$141.97	$174.78	$299.89
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.89 / $52.27 / $114.84	Professional	26	$41.89	$52.27	$114.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.08 / $124.51 / $177.30	Professional	TC	$100.08	$124.51	$177.30
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.96 / $140.76 / $173.25	Professional		$131.96	$140.76	$173.25
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $43.59 / $61.75	Professional	26	$39.97	$43.59	$61.75
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $22.65 / $22.65 / $67.93	Professional	52	$22.65	$22.65	$67.93
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $108.30 / $108.30 / $147.66	Professional	TC	$108.30	$108.30	$147.66
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $38.22 / $42.30 / $277.61	Professional	26	$38.22	$42.30	$277.61
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $34.43 / $47.51 / $111.28	Facility	26	$34.43	$47.51	$111.28
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $101.16 / $143.69 / $553.00	Professional		$101.16	$143.69	$553.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $43.63 / $94.82	Professional	26	$34.07	$43.63	$94.82
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $13.62 / $13.62 / $13.62	Professional	52	$13.62	$13.62	$13.62
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $75.76 / $100.14 / $254.87	Professional	TC	$75.76	$100.14	$254.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.03 / $106.30 / $204.54	Professional		$43.03	$106.30	$204.54
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $43.97 / $43.97 / $43.97	Facility	26	$43.97	$43.97	$43.97
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $100.29 / $157.58 / $249.28	Professional		$100.29	$157.58	$249.28
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $47.44 / $76.80	Professional	26	$28.11	$47.44	$76.80
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.72 / $110.47 / $172.33	Professional	TC	$68.72	$110.47	$172.33
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $37.85 / $37.85 / $43.44	Facility	26	$37.85	$37.85	$43.44
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $118.87 / $120.67 / $142.44	Professional		$118.87	$120.67	$142.44
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $36.89 / $37.85 / $43.44	Professional	26	$36.89	$37.85	$43.44
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $82.83 / $99.00	Professional	TC	$81.02	$82.83	$99.00
United Facility/Professional Professional Modifier Low / Median / High Price $116.75 / $150.06 / $242.93	Professional		$116.75	$150.06	$242.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.00 / $46.91 / $80.52	Professional	26	$37.00	$46.91	$80.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.75 / $106.18 / $166.35	Professional	TC	$79.75	$106.18	$166.35