Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $64.57 / $131.83	Facility	26	$32.36	$64.57	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $588.84	Professional		$109.65	$190.55	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $48.98 / $123.03	Professional	26	$32.36	$48.98	$123.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $95.50 / $616.60	Professional	52	$17.78	$95.50	$616.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $323.59	Professional	TC	$79.43	$112.20	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $102.33 / $190.55	Professional		$83.18	$102.33	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $33.88 / $60.26	Professional	26	$27.54	$33.88	$60.26
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $25.12 / $25.12 / $42.66	Professional	52	$25.12	$25.12	$42.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $77.62 / $134.90	Professional	TC	$61.66	$77.62	$134.90
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $245.47	Professional		$123.03	$158.49	$245.47
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $45.71 / $70.79	Professional	26	$36.31	$45.71	$70.79
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $114.82 / $181.97	Professional	TC	$87.10	$114.82	$181.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $41.69 / $58.88	Facility	26	$8.91	$41.69	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $162.18 / $263.03	Professional		$100.00	$162.18	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $44.67 / $72.44	Professional	26	$26.30	$44.67	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $117.49 / $190.55	Professional	TC	$72.44	$117.49	$190.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $169.82 / $213.80	Professional		$131.83	$169.82	$213.80
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $57.54	Professional	26	$35.48	$46.77	$57.54
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $125.89 / $158.49	Professional	TC	$97.72	$125.89	$158.49
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $141.25 / $263.03	Professional		$104.71	$141.25	$263.03
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $40.74 / $75.86	Professional	26	$29.51	$40.74	$75.86
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $100.00 / $186.21	Professional	TC	$75.86	$100.00	$186.21
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $141.25 / $181.97	Professional		$134.90	$141.25	$181.97
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $38.90 / $54.95	Professional	26	$36.31	$38.90	$54.95
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $19.50 / $22.91 / $79.43	Professional	52	$19.50	$22.91	$79.43
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $128.82 / $158.49	Professional	TC	$100.00	$128.82	$158.49
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $158.49 / $194.98	Professional		$138.04	$158.49	$194.98
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $48.98	Professional	26	$38.02	$38.02	$48.98
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $56.23 / $123.03	Facility	26	$33.88	$56.23	$123.03
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $169.82 / $363.08	Professional		$112.20	$169.82	$363.08
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $47.86 / $102.33	Professional	26	$32.36	$47.86	$102.33
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $17.78 / $61.66 / $478.63	Professional	52	$17.78	$61.66	$478.63
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $114.82 / $239.88	Professional	TC	$79.43	$114.82	$239.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $102.33 / $229.09	Professional		$39.81	$102.33	$229.09
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $35.48 / $40.74	Facility	26	$35.48	$35.48	$40.74
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $104.71 / $173.78	Professional		$57.54	$104.71	$173.78
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $35.48 / $37.15	Professional	26	$34.67	$35.48	$37.15
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $87.10 / $95.50	Professional	TC	$85.11	$87.10	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $147.91 / $229.09	Professional		$112.20	$147.91	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $42.66 / $66.07	Professional	26	$29.51	$42.66	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $169.82	Professional	TC	$79.43	$109.65	$169.82