Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.14 / $120.25 / $244.20	Facility	26	$76.14	$120.25	$244.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $395.80 / $553.90 / $2,470.65	Professional		$395.80	$553.90	$2,470.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.83 / $109.53 / $380.00	Professional	26	$70.83	$109.53	$380.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $319.77 / $443.98 / $2,178.00	Professional	TC	$319.77	$443.98	$2,178.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $325.22 / $325.22 / $337.39	Professional		$325.22	$325.22	$337.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.48 / $117.06 / $152.18	Professional	26	$65.48	$117.06	$152.18
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $71.22 / $89.72 / $144.85	Professional	26	$71.22	$89.72	$144.85
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $424.08 / $551.36 / $918.42	Professional		$424.08	$551.36	$918.42
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $82.72 / $129.43 / $181.16	Professional	26	$82.72	$129.43	$181.16
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $341.36 / $413.49 / $770.14	Professional	TC	$341.36	$413.49	$770.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.59 / $93.59 / $93.59	Facility	26	$93.59	$93.59	$93.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $340.56 / $537.21 / $899.73	Professional		$340.56	$537.21	$899.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.47 / $95.30 / $154.59	Professional	26	$66.47	$95.30	$154.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $263.19 / $439.12 / $749.74	Professional	TC	$263.19	$439.12	$749.74
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $499.80 / $581.22 / $688.37	Professional		$499.80	$581.22	$688.37
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.38 / $110.38 / $122.98	Professional	26	$91.38	$110.38	$122.98
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $408.41 / $508.78 / $565.39	Professional	TC	$408.41	$508.78	$565.39
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $1,290.99 / $1,290.99 / $1,290.99	Facility	26	$1,290.99	$1,290.99	$1,290.99
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $496.34 / $503.26 / $874.71	Professional		$496.34	$503.26	$874.71
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $92.70 / $133.77	Professional	26	$89.13	$92.70	$133.77
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $82.62 / $87.68 / $144.85	Professional	26	$82.62	$87.68	$144.85
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $76.14 / $122.10 / $269.11	Facility	26	$76.14	$122.10	$269.11
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $414.69 / $588.97 / $1,531.95	Professional		$414.69	$588.97	$1,531.95
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $72.52 / $114.07 / $294.00	Professional	26	$72.52	$114.07	$294.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $338.55 / $475.99 / $1,300.85	Professional	TC	$338.55	$475.99	$1,300.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.21 / $561.95 / $918.00	Professional		$123.21	$561.95	$918.00
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $93.59 / $93.59 / $93.59	Facility	26	$93.59	$93.59	$93.59
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $354.82 / $539.02 / $899.73	Professional		$354.82	$539.02	$899.73
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.31 / $96.04 / $159.62	Professional	26	$69.31	$96.04	$159.62
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $274.10 / $448.23 / $751.64	Professional	TC	$274.10	$448.23	$751.64
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $80.94 / $80.94 / $85.50	Facility	26	$80.94	$80.94	$85.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $423.57 / $431.55 / $471.50	Professional		$423.57	$431.55	$471.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.09 / $80.94 / $85.50	Professional	26	$79.09	$80.94	$85.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $342.84 / $350.61 / $386.00	Professional	TC	$342.84	$350.61	$386.00
United Facility/Professional Professional Modifier Low / Median / High Price $361.64 / $551.70 / $906.85	Professional		$361.64	$551.70	$906.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.06 / $95.91 / $156.18	Professional	26	$75.06	$95.91	$156.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $351.98 / $465.66 / $782.52	Professional	TC	$351.98	$465.66	$782.52