Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.87 / $144.00 / $265.02	Facility		$54.87	$144.00	$265.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.10 / $40.10 / $109.69	Facility	26	$23.10	$40.10	$109.69
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $56.79 / $155.33 / $364.33	Facility	TC	$56.79	$155.33	$364.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.88 / $88.98 / $122.82	Professional		$50.88	$88.98	$122.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $47.79 / $143.44	Professional	26	$20.98	$47.79	$143.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.06 / $41.18 / $62.51	Professional	TC	$29.06	$41.18	$62.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.62 / $30.76 / $62.19	Professional		$29.62	$30.76	$62.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.05 / $25.31 / $44.15	Professional	26	$13.05	$25.31	$44.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.14 / $18.14 / $36.88	Professional	TC	$18.14	$18.14	$36.88
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $27.92 / $35.70	Professional	26	$26.76	$27.92	$35.70
Capital Blue Cross Facility/Professional Facility Modifier TC Low / Median / High Price $143.27 / $199.39 / $281.93	Facility	TC	$143.27	$199.39	$281.93
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $65.92 / $68.41 / $141.38	Professional		$65.92	$68.41	$141.38
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $26.83 / $27.84 / $66.70	Professional	26	$26.83	$27.84	$66.70
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $39.09 / $40.57 / $68.90	Professional	TC	$39.09	$40.57	$68.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.55 / $67.55 / $173.88	Facility		$67.55	$67.55	$173.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.18 / $97.18 / $97.18	Facility	26	$97.18	$97.18	$97.18
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $76.69 / $76.69 / $76.69	Facility	TC	$76.69	$76.69	$76.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.10 / $60.21 / $132.47	Professional		$31.10	$60.21	$132.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $28.27 / $67.84	Professional	26	$12.65	$28.27	$67.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.44 / $28.29 / $59.49	Professional	TC	$18.44	$28.29	$59.49
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.63 / $98.13 / $129.81	Professional		$42.63	$98.13	$129.81
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.41 / $37.11 / $48.74	Professional	26	$16.41	$37.11	$48.74
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.21 / $61.02 / $81.06	Professional	TC	$26.21	$61.02	$81.06
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $256.20 / $256.20 / $256.20	Facility		$256.20	$256.20	$256.20
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $170.23 / $170.23 / $192.34	Facility	TC	$170.23	$170.23	$192.34
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.18 / $90.52 / $145.19	Professional		$67.18	$90.52	$145.19
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.66 / $31.91 / $70.97	Professional	26	$27.66	$31.91	$70.97
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $26.76 / $27.92 / $35.70	Professional	26	$26.76	$27.92	$35.70
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $67.94 / $144.00 / $265.02	Facility		$67.94	$144.00	$265.02
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $23.10 / $40.10 / $109.69	Facility	26	$23.10	$40.10	$109.69
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $55.68 / $155.33 / $428.45	Facility	TC	$55.68	$155.33	$428.45
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $52.25 / $88.98 / $130.91	Professional		$52.25	$88.98	$130.91
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $44.29 / $121.30	Professional	26	$22.00	$44.29	$121.30
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $30.26 / $47.36 / $81.40	Professional	TC	$30.26	$47.36	$81.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.18 / $62.32 / $120.54	Professional		$36.18	$62.32	$120.54
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $67.55 / $67.55 / $173.88	Facility		$67.55	$67.55	$173.88
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $97.18 / $97.18 / $97.18	Facility	26	$97.18	$97.18	$97.18
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $76.69 / $76.69 / $76.69	Facility	TC	$76.69	$76.69	$76.69
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $31.10 / $61.58 / $132.47	Professional		$31.10	$61.58	$132.47
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $28.27 / $67.84	Professional	26	$12.65	$28.27	$67.84
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.44 / $33.57 / $59.91	Professional	TC	$18.44	$33.57	$59.91
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $63.27 / $65.45 / $119.50	Professional		$63.27	$65.45	$119.50
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $27.09 / $67.00	Professional	26	$26.45	$27.09	$67.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $36.83 / $38.36 / $52.50	Professional	TC	$36.83	$38.36	$52.50
United Facility/Professional Professional Modifier Low / Median / High Price $40.46 / $68.41 / $125.10	Professional		$40.46	$68.41	$125.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.27 / $28.83 / $52.40	Professional	26	$16.27	$28.83	$52.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $38.33 / $67.48	Professional	TC	$23.82	$38.33	$67.48