Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $85.11 / $158.49	Facility	26	$42.66	$85.11	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $223.87 / $891.25	Professional		$134.90	$223.87	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $64.57 / $134.90	Professional	26	$42.66	$64.57	$134.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $134.90 / $371.54	Professional	TC	$95.50	$134.90	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $125.89 / $213.80	Professional		$102.33	$125.89	$213.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $79.43	Professional	26	$37.15	$57.54	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $93.33 / $165.96	Professional	TC	$91.20	$93.33	$165.96
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $194.98 / $309.03	Professional		$154.88	$194.98	$309.03
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $93.33	Professional	26	$46.77	$58.88	$93.33
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $138.04 / $223.87	Professional	TC	$107.15	$138.04	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $199.53 / $323.59	Professional		$123.03	$199.53	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $58.88 / $95.50	Professional	26	$34.67	$58.88	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $144.54 / $229.09	Professional	TC	$89.13	$144.54	$229.09
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $213.80 / $269.15	Professional		$165.96	$213.80	$269.15
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $75.86	Professional	26	$46.77	$61.66	$75.86
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $190.55	Professional	TC	$117.49	$151.36	$190.55
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $323.59	Professional		$128.82	$173.78	$323.59
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $100.00	Professional	26	$38.90	$53.70	$100.00
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $120.23 / $223.87	Professional	TC	$91.20	$120.23	$223.87
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	26	$53.70	$53.70	$53.70
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $181.97 / $204.17	Professional		$169.82	$181.97	$204.17
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $51.29 / $69.18	Professional	26	$47.86	$51.29	$69.18
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $190.55	Professional	TC	$154.88	$154.88	$190.55
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $234.42	Professional		$234.42	$234.42	$234.42
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $63.10	Professional	26	$48.98	$48.98	$63.10
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $70.79 / $158.49	Facility	26	$42.66	$70.79	$158.49
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $204.17 / $436.52	Professional		$138.04	$204.17	$436.52
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $61.66 / $128.82	Professional	26	$42.66	$61.66	$128.82
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $281.84	Professional	TC	$95.50	$138.04	$281.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $131.83 / $288.40	Professional		$52.48	$131.83	$288.40
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $51.29 / $53.70	Facility	26	$46.77	$51.29	$53.70
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $165.96 / $181.97	Professional		$120.23	$165.96	$181.97
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $47.86 / $53.70	Professional	26	$45.71	$47.86	$53.70
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $107.15 / $125.89	Professional	TC	$102.33	$107.15	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $181.97 / $281.84	Professional		$138.04	$181.97	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $56.23 / $87.10	Professional	26	$38.90	$56.23	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $131.83 / $204.17	Professional	TC	$95.50	$131.83	$204.17