Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.24 / $486.89 / $574.52	Facility	26	$199.24	$486.89	$574.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $253.81 / $340.52 / $574.36	Professional		$253.81	$340.52	$574.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.21 / $149.78 / $568.63	Professional	26	$108.21	$149.78	$568.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.77 / $225.78 / $347.95	Professional	TC	$158.77	$225.78	$347.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.32 / $190.32 / $190.32	Professional		$190.32	$190.32	$190.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $68.28 / $197.93 / $263.89	Professional	26	$68.28	$197.93	$263.89
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $139.91 / $147.21 / $188.25	Professional	26	$139.91	$147.21	$188.25
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $350.80 / $430.78 / $714.62	Professional		$350.80	$430.78	$714.62
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $139.87 / $201.06 / $281.24	Professional	26	$139.87	$201.06	$281.24
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $133.52 / $285.64 / $476.39	Professional	TC	$133.52	$285.64	$476.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $251.40 / $251.40 / $251.40	Facility	26	$251.40	$251.40	$251.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.44 / $217.52 / $547.54	Professional		$141.44	$217.52	$547.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.13 / $86.21 / $196.24	Professional	26	$64.13	$86.21	$196.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.05 / $136.10 / $350.55	Professional	TC	$68.05	$136.10	$350.55
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $270.33 / $624.37 / $824.74	Professional		$270.33	$624.37	$824.74
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.87 / $194.54 / $255.09	Professional	26	$85.87	$194.54	$255.09
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.46 / $429.84 / $569.63	Professional	TC	$184.46	$429.84	$569.63
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $466.89 / $466.89 / $466.89	Professional		$466.89	$466.89	$466.89
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.60 / $162.18 / $229.90	Professional	26	$123.60	$162.18	$229.90
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $139.91 / $147.21 / $188.25	Professional	26	$139.91	$147.21	$188.25
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $199.24 / $574.52 / $574.52	Facility	26	$199.24	$574.52	$574.52
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $300.18 / $420.26 / $859.78	Professional		$300.18	$420.26	$859.78
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $114.73 / $193.74 / $549.12	Professional	26	$114.73	$193.74	$549.12
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $210.96 / $273.47 / $585.22	Professional	TC	$210.96	$273.47	$585.22
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $138.63 / $384.31 / $709.67	Professional		$138.63	$384.31	$709.67
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.40 / $251.40 / $251.40	Facility	26	$251.40	$251.40	$251.40
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $148.63 / $249.35 / $586.23	Professional		$148.63	$249.35	$586.23
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.13 / $109.81 / $199.09	Professional	26	$64.13	$109.81	$199.09
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.31 / $150.24 / $385.79	Professional	TC	$77.31	$150.24	$385.79
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $205.60 / $413.99 / $451.94	Professional		$205.60	$413.99	$451.94
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $122.76 / $139.11 / $144.63	Professional	26	$122.76	$139.11	$144.63
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $82.84 / $277.64 / $307.30	Professional	TC	$82.84	$277.64	$307.30
United Facility/Professional Professional Modifier Low / Median / High Price $181.82 / $407.15 / $769.64	Professional		$181.82	$407.15	$769.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.20 / $149.44 / $241.47	Professional	26	$82.20	$149.44	$241.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $257.70 / $475.19	Professional	TC	$141.72	$257.70	$475.19