Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.89 / $43.19 / $75.01	Facility	26	$34.89	$43.19	$75.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $256.76 / $311.04 / $1,639.00	Professional		$256.76	$311.04	$1,639.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $49.16 / $186.00	Professional	26	$32.11	$49.16	$186.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $264.48 / $488.29	Professional	TC	$218.71	$264.48	$488.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.46 / $218.46 / $218.46	Professional		$218.46	$218.46	$218.46
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.10 / $53.49 / $60.87	Professional	26	$30.10	$53.49	$60.87
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $42.87 / $47.46 / $322.33	Professional	26	$42.87	$47.46	$322.33
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $284.22 / $331.23 / $603.86	Professional		$284.22	$331.23	$603.86
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $36.94 / $62.01 / $90.70	Professional	26	$36.94	$62.01	$90.70
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $247.28 / $262.23 / $533.29	Professional	TC	$247.28	$262.23	$533.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.12 / $42.12 / $42.12	Facility	26	$42.12	$42.12	$42.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $205.40 / $332.88 / $560.05	Professional		$205.40	$332.88	$560.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.26 / $45.15 / $68.19	Professional	26	$26.26	$45.15	$68.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.13 / $283.13 / $494.57	Professional	TC	$165.13	$283.13	$494.57
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $416.84 / $416.84 / $464.83	Professional		$416.84	$416.84	$464.83
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.45 / $48.45 / $54.39	Professional	26	$48.45	$48.45	$54.39
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $368.39 / $368.39 / $410.45	Professional	TC	$368.39	$368.39	$410.45
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.44 / $44.74 / $64.52	Professional	26	$38.44	$44.74	$64.52
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $42.87 / $46.06 / $322.33	Professional	26	$42.87	$46.06	$322.33
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $33.22 / $47.52 / $114.20	Facility	26	$33.22	$47.52	$114.20
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $268.12 / $344.96 / $1,398.00	Professional		$268.12	$344.96	$1,398.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $33.22 / $52.25 / $111.34	Professional	26	$33.22	$52.25	$111.34
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $233.28 / $281.89 / $603.24	Professional	TC	$233.28	$281.89	$603.24
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $42.12 / $42.12 / $42.12	Facility	26	$42.12	$42.12	$42.12
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $215.74 / $348.57 / $581.36	Professional		$215.74	$348.57	$581.36
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $45.30 / $73.31	Professional	26	$28.75	$45.30	$73.31
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.68 / $301.39 / $511.75	Professional	TC	$173.68	$301.39	$511.75
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $36.54 / $36.54 / $42.50	Facility	26	$36.54	$36.54	$42.50
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $293.23 / $320.43	Professional		$255.00	$293.23	$320.43
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $35.60 / $36.56 / $42.50	Professional	26	$35.60	$36.56	$42.50
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $212.50 / $256.69 / $282.58	Professional	TC	$212.50	$256.69	$282.58
United Facility/Professional Professional Modifier Low / Median / High Price $240.09 / $343.57 / $554.24	Professional		$240.09	$343.57	$554.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.11 / $43.67 / $71.98	Professional	26	$35.11	$43.67	$71.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $233.28 / $317.24 / $538.29	Professional	TC	$233.28	$317.24	$538.29