Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $82.39 / $209.44 / $640.89	Facility		$82.39	$209.44	$640.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.53 / $101.65 / $278.02	Facility	26	$58.53	$101.65	$278.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.58 / $134.71 / $321.10	Professional		$95.58	$134.71	$321.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.25 / $106.04 / $424.10	Professional	26	$53.25	$106.04	$424.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $71.73 / $155.60	Professional	TC	$50.22	$71.73	$155.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.48 / $76.48 / $76.48	Professional		$76.48	$76.48	$76.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $97.99 / $124.51	Professional	26	$32.97	$97.99	$124.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.55 / $93.55 / $93.55	Professional	TC	$93.55	$93.55	$93.55
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $67.58 / $71.31 / $91.20	Professional	26	$67.58	$71.31	$91.20
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $166.84 / $224.29 / $339.75	Professional		$166.84	$224.29	$339.75
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $67.68 / $97.30 / $171.47	Professional	26	$67.68	$97.30	$171.47
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $99.16 / $120.32 / $168.29	Professional	TC	$99.16	$120.32	$168.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $163.41 / $163.41 / $228.07	Facility		$163.41	$163.41	$228.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.28 / $115.28 / $115.28	Facility	26	$115.28	$115.28	$115.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.08 / $91.49 / $212.49	Professional		$62.08	$91.49	$212.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $42.77 / $94.18	Professional	26	$31.93	$42.77	$94.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.22 / $48.24 / $112.26	Professional	TC	$29.22	$48.24	$112.26
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $107.99 / $248.55 / $329.25	Professional		$107.99	$248.55	$329.25
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.45 / $93.84 / $123.03	Professional	26	$41.45	$93.84	$123.03
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.54 / $154.71 / $206.23	Professional	TC	$66.54	$154.71	$206.23
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.50 / $257.50 / $257.50	Facility		$257.50	$257.50	$257.50
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.18 / $194.18 / $226.11	Professional		$194.18	$194.18	$226.11
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.83 / $79.93 / $111.15	Professional	26	$69.83	$79.93	$111.15
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $67.58 / $71.31 / $91.20	Professional	26	$67.58	$71.31	$91.20
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $133.94 / $237.67 / $640.89	Facility		$133.94	$237.67	$640.89
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $58.53 / $101.65 / $278.02	Facility	26	$58.53	$101.65	$278.02
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $119.93 / $157.40 / $377.32	Professional		$119.93	$157.40	$377.32
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $55.75 / $102.02 / $367.02	Professional	26	$55.75	$102.02	$367.02
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $67.84 / $88.09 / $194.98	Professional	TC	$67.84	$88.09	$194.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $92.08 / $157.52 / $290.56	Professional		$92.08	$157.52	$290.56
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $163.41 / $163.41 / $228.07	Facility		$163.41	$163.41	$228.07
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $115.28 / $115.28 / $115.28	Facility	26	$115.28	$115.28	$115.28
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $62.21 / $100.17 / $220.10	Professional		$62.21	$100.17	$220.10
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.93 / $60.64 / $103.87	Professional	26	$31.93	$60.64	$103.87
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.41 / $53.22 / $113.84	Professional	TC	$29.41	$53.22	$113.84
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $115.63 / $153.18 / $166.63	Professional		$115.63	$153.18	$166.63
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $66.98 / $68.67 / $74.87	Professional	26	$66.98	$68.67	$74.87
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.76 / $87.22 / $96.74	Professional	TC	$40.76	$87.22	$96.74
United Facility/Professional Professional Modifier Low / Median / High Price $75.29 / $150.63 / $225.96	Professional		$75.29	$150.63	$225.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.88 / $72.51 / $108.77	Professional	26	$39.88	$72.51	$108.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.97 / $78.13 / $117.19	Professional	TC	$42.97	$78.13	$117.19