Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.65 / $89.34 / $178.14	Facility	26	$55.65	$89.34	$178.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.61 / $220.51 / $843.50	Professional		$109.61	$220.51	$843.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.92 / $217.65 / $832.40	Professional	26	$56.92	$217.65	$832.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.36 / $94.98 / $389.70	Professional	TC	$54.36	$94.98	$389.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.20 / $98.20 / $98.20	Professional		$98.20	$98.20	$98.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.12 / $85.94 / $111.72	Professional	26	$48.12	$85.94	$111.72
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $52.49 / $66.16 / $106.82	Professional	26	$52.49	$66.16	$106.82
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $123.66 / $197.38 / $315.75	Professional		$123.66	$197.38	$315.75
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $60.73 / $95.54 / $143.94	Professional	26	$60.73	$95.54	$143.94
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $62.93 / $101.75 / $206.19	Professional	TC	$62.93	$101.75	$206.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	26	$68.78	$68.78	$68.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.17 / $175.77 / $280.14	Professional		$113.17	$175.77	$280.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.18 / $74.59 / $117.58	Professional	26	$49.18	$74.59	$117.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.00 / $101.92 / $167.26	Professional	TC	$60.00	$101.92	$167.26
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $142.36 / $194.48 / $213.48	Professional		$142.36	$194.48	$213.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.03 / $81.00 / $90.10	Professional	26	$67.03	$81.00	$90.10
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $93.78 / $104.38	Professional	TC	$75.31	$93.78	$104.38
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $459.02 / $459.02 / $971.88	Facility	26	$459.02	$459.02	$971.88
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.58 / $216.90 / $245.54	Professional		$141.58	$216.90	$245.54
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.48 / $71.56 / $98.42	Professional	26	$65.48	$71.56	$98.42
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $60.93 / $64.66 / $106.82	Professional	26	$60.93	$64.66	$106.82
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $55.65 / $89.34 / $196.31	Facility	26	$55.65	$89.34	$196.31
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $117.86 / $212.16 / $807.33	Professional		$117.86	$212.16	$807.33
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $58.33 / $159.24 / $750.97	Professional	26	$58.33	$159.24	$750.97
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $57.39 / $94.98 / $263.39	Professional	TC	$57.39	$94.98	$263.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.87 / $123.96 / $261.76	Professional		$87.87	$123.96	$261.76
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	26	$68.78	$68.78	$68.78
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $113.17 / $181.65 / $280.14	Professional		$113.17	$181.65	$280.14
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.38 / $75.00 / $118.21	Professional	26	$51.38	$75.00	$118.21
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.00 / $102.97 / $164.76	Professional	TC	$60.00	$102.97	$164.76
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $59.17 / $59.17 / $66.00	Facility	26	$59.17	$59.17	$66.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $118.88 / $120.50 / $203.00	Professional		$118.88	$120.50	$203.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.89 / $59.17 / $66.00	Professional	26	$57.89	$59.17	$66.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $60.01 / $61.33 / $137.00	Professional	TC	$60.01	$61.33	$137.00
United Facility/Professional Professional Modifier Low / Median / High Price $112.27 / $162.16 / $240.26	Professional		$112.27	$162.16	$240.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.35 / $73.29 / $114.26	Professional	26	$55.35	$73.29	$114.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.92 / $85.37 / $139.74	Professional	TC	$56.92	$85.37	$139.74