Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.00 / $198.91 / $442.41	Facility		$88.00	$198.91	$442.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.95 / $38.59 / $105.56	Facility	26	$21.95	$38.59	$105.56
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $116.81 / $285.45 / $528.00	Facility	TC	$116.81	$285.45	$528.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.34 / $111.33 / $360.00	Professional		$83.34	$111.33	$360.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.91 / $51.40 / $199.21	Professional	26	$20.91	$51.40	$199.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.46 / $81.27 / $107.89	Professional	TC	$46.46	$81.27	$107.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.19 / $50.86 / $101.72	Professional		$50.19	$50.86	$101.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.56 / $38.97 / $48.72	Professional	26	$12.56	$38.97	$48.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.68 / $38.68 / $77.36	Professional	TC	$38.68	$38.68	$77.36
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $113.72 / $116.52 / $149.01	Professional		$113.72	$116.52	$149.01
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $26.87 / $34.36	Professional	26	$25.76	$26.87	$34.36
Capital Blue Cross Facility/Professional Facility Modifier TC Low / Median / High Price $228.34 / $317.79 / $449.33	Facility	TC	$228.34	$317.79	$449.33
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $107.82 / $115.47 / $185.28	Professional		$107.82	$115.47	$185.28
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $25.82 / $38.04 / $66.70	Professional	26	$25.82	$38.04	$66.70
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $65.75 / $85.10 / $141.30	Professional	TC	$65.75	$85.10	$141.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $142.18 / $142.18 / $180.72	Facility		$142.18	$142.18	$180.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.57 / $45.57 / $45.57	Facility	26	$45.57	$45.57	$45.57
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $135.15 / $135.15 / $135.15	Facility	TC	$135.15	$135.15	$135.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.27 / $57.37 / $137.33	Professional		$40.27	$57.37	$137.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.18 / $16.26 / $37.61	Professional	26	$12.18	$16.26	$37.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.80 / $43.73 / $97.40	Professional	TC	$28.80	$43.73	$97.40
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $70.78 / $163.72 / $216.93	Professional		$70.78	$163.72	$216.93
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.80 / $35.71 / $46.91	Professional	26	$15.80	$35.71	$46.91
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.99 / $128.01 / $170.01	Professional	TC	$54.99	$128.01	$170.01
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $124.64 / $127.38 / $134.07	Facility		$124.64	$127.38	$134.07
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.25 / $123.60 / $157.53	Professional		$107.25	$123.60	$157.53
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.62 / $30.71 / $43.22	Professional	26	$26.62	$30.71	$43.22
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.74 / $88.75 / $144.54	Professional	TC	$44.74	$88.75	$144.54
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $113.72 / $116.52 / $149.01	Professional		$113.72	$116.52	$149.01
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $26.87 / $34.36	Professional	26	$25.76	$26.87	$34.36
Independence Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $95.07 / $95.07 / $95.07	Professional	TC	$95.07	$95.07	$95.07
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $44.00 / $198.91 / $442.41	Facility		$44.00	$198.91	$442.41
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $21.95 / $38.59 / $105.56	Facility	26	$21.95	$38.59	$105.56
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $116.81 / $254.00 / $759.00	Facility	TC	$116.81	$254.00	$759.00
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $88.01 / $115.99 / $289.60	Professional		$88.01	$115.99	$289.60
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $20.91 / $40.15 / $157.61	Professional	26	$20.91	$40.15	$157.61
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $67.09 / $87.22 / $161.78	Professional	TC	$67.09	$87.22	$161.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.64 / $106.55 / $185.41	Professional		$25.64	$106.55	$185.41
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $142.18 / $142.18 / $180.72	Facility		$142.18	$142.18	$180.72
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $45.57 / $45.57 / $45.57	Facility	26	$45.57	$45.57	$45.57
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $135.15 / $135.15 / $135.15	Facility	TC	$135.15	$135.15	$135.15
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $41.98 / $63.85 / $140.65	Professional		$41.98	$63.85	$140.65
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.18 / $23.73 / $39.69	Professional	26	$12.18	$23.73	$39.69
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.12 / $46.71 / $102.89	Professional	TC	$30.12	$46.71	$102.89
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $79.31 / $106.16 / $116.29	Professional		$79.31	$106.16	$116.29
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.46 / $26.07 / $36.00	Professional	26	$25.46	$26.07	$36.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $50.17 / $81.13 / $89.79	Professional	TC	$50.17	$81.13	$89.79
United Facility/Professional Professional Modifier Low / Median / High Price $55.22 / $101.68 / $179.76	Professional		$55.22	$101.68	$179.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.00 / $27.27 / $44.58	Professional	26	$15.00	$27.27	$44.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.92 / $74.41 / $120.04	Professional	TC	$40.92	$74.41	$120.04