Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.92 / $42.00 / $117.85	Facility	26	$33.92	$42.00	$117.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.11 / $147.29 / $576.79	Professional		$109.11	$147.29	$576.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.53 / $39.14 / $122.91	Professional	26	$31.53	$39.14	$122.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.89 / $137.69 / $726.00	Professional	52	$23.89	$137.69	$726.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.73 / $98.52 / $244.84	Professional	TC	$79.73	$98.52	$244.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.57 / $111.03 / $234.46	Professional		$83.57	$111.03	$234.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $37.29 / $59.78	Professional	26	$27.34	$37.29	$59.78
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $19.10 / $23.80 / $127.93	Professional	52	$19.10	$23.80	$127.93
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.73 / $135.19 / $136.87	Professional	TC	$67.73	$135.19	$136.87
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $138.31 / $138.31 / $185.79	Professional		$138.31	$138.31	$185.79
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $42.04 / $117.26	Professional	26	$37.79	$42.04	$117.26
AmeriHealth Facility/Professional Professional Modifier TC Low / Median / High Price $100.53 / $109.17 / $388.32	Professional	TC	$100.53	$109.17	$388.32
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $124.26 / $202.12 / $247.80	Professional		$124.26	$202.12	$247.80
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $36.22 / $58.71 / $70.23	Professional	26	$36.22	$58.71	$70.23
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $88.04 / $143.44 / $182.82	Professional	TC	$88.04	$143.44	$182.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.65 / $161.87 / $254.76	Professional		$99.65	$161.87	$254.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.08 / $44.79 / $71.36	Professional	26	$26.08	$44.79	$71.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.97 / $117.96 / $182.08	Professional	TC	$71.97	$117.96	$182.08
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $145.05 / $178.84 / $333.48	Professional		$145.05	$178.84	$333.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.70 / $49.49 / $135.10	Professional	26	$39.70	$49.49	$135.10
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.35 / $131.21 / $198.43	Professional	TC	$105.35	$131.21	$198.43
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $45.41 / $45.41 / $45.41	Facility	26	$45.41	$45.41	$45.41
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.16 / $141.12 / $178.95	Professional		$131.16	$141.12	$178.95
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $40.60 / $60.31	Professional	26	$37.68	$40.60	$60.31
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $19.38 / $21.59 / $76.95	Professional	52	$19.38	$21.59	$76.95
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $127.45 / $130.11 / $156.13	Professional	TC	$127.45	$130.11	$156.13
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $138.31 / $138.31 / $158.22	Professional		$138.31	$138.31	$158.22
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $42.04 / $303.24	Professional	26	$37.79	$42.04	$303.24
Independence Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $100.53 / $109.17 / $388.32	Professional	TC	$100.53	$109.17	$388.32
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $32.31 / $46.09 / $115.04	Facility	26	$32.31	$46.09	$115.04
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $112.12 / $157.12 / $553.86	Professional		$112.12	$157.12	$553.86
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $32.31 / $43.61 / $104.48	Professional	26	$32.31	$43.61	$104.48
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $20.49 / $107.45 / $622.50	Professional	52	$20.49	$107.45	$622.50
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $79.81 / $106.81 / $246.68	Professional	TC	$79.81	$106.81	$246.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.78 / $102.80 / $208.42	Professional		$40.78	$102.80	$208.42
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $102.29 / $161.10 / $254.76	Professional		$102.29	$161.10	$254.76
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.39 / $44.79 / $72.20	Professional	26	$26.39	$44.79	$72.20
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.65 / $116.72 / $182.08	Professional	TC	$72.65	$116.72	$182.08
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $35.84 / $35.84 / $41.06	Facility	26	$35.84	$35.84	$41.06
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $121.51 / $123.40 / $145.63	Professional		$121.51	$123.40	$145.63
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $34.92 / $35.85 / $41.06	Professional	26	$34.92	$35.85	$41.06
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $85.66 / $87.57 / $104.57	Professional	TC	$85.66	$87.57	$104.57
United Facility/Professional Professional Modifier Low / Median / High Price $119.08 / $153.38 / $258.12	Professional		$119.08	$153.38	$258.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.56 / $44.43 / $71.68	Professional	26	$34.56	$44.43	$71.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.31 / $113.23 / $177.08	Professional	TC	$84.31	$113.23	$177.08