Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $170.93 / $535.04 / $1,195.24	Facility		$170.93	$535.04	$1,195.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $60.67 / $165.94	Facility	26	$34.67	$60.67	$165.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.66 / $121.56 / $323.36	Professional		$89.66	$121.56	$323.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.02 / $104.49 / $407.14	Professional	26	$33.02	$104.49	$407.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.04 / $73.48 / $304.27	Professional	TC	$52.04	$73.48	$304.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $109.05 / $109.05	Professional		$109.05	$109.05	$109.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.57 / $56.99 / $74.08	Professional	26	$19.57	$56.99	$74.08
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $71.06 / $71.06 / $71.06	Professional	TC	$71.06	$71.06	$71.06
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $42.20 / $53.97	Professional	26	$40.11	$42.20	$53.97
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $115.59 / $119.96 / $234.59	Professional		$115.59	$119.96	$234.59
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $40.27 / $41.79 / $82.84	Professional	26	$40.27	$41.79	$82.84
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $78.17 / $151.77	Professional	TC	$75.31	$78.17	$151.77
Cigna Facility/Professional Facility Modifier Low / Median / High Price $131.28 / $131.28 / $209.62	Facility		$131.28	$131.28	$209.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.87 / $90.87 / $90.87	Facility	26	$90.87	$90.87	$90.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.36 / $77.95 / $166.91	Professional		$54.36	$77.95	$166.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $29.41 / $70.22	Professional	26	$19.55	$29.41	$70.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.38 / $42.54 / $91.63	Professional	TC	$28.38	$42.54	$91.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $75.06 / $173.29 / $228.69	Professional		$75.06	$173.29	$228.69
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.59 / $55.65 / $72.84	Professional	26	$24.59	$55.65	$72.84
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.48 / $117.64 / $155.85	Professional	TC	$50.48	$117.64	$155.85
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $823.76 / $823.76 / $823.76	Facility		$823.76	$823.76	$823.76
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.06 / $139.88 / $168.13	Professional		$121.06	$139.88	$168.13
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.48 / $48.55 / $71.02	Professional	26	$41.48	$48.55	$71.02
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $42.20 / $53.97	Professional	26	$40.11	$42.20	$53.97
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $164.66 / $467.52 / $954.03	Facility		$164.66	$467.52	$954.03
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $60.67 / $165.94	Facility	26	$34.67	$60.67	$165.94
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $94.59 / $133.72 / $323.36	Professional		$94.59	$133.72	$323.36
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $33.02 / $86.60 / $389.10	Professional	26	$33.02	$86.60	$389.10
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $61.57 / $83.62 / $221.50	Professional	TC	$61.57	$83.62	$221.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.83 / $108.04 / $200.12	Professional		$39.83	$108.04	$200.12
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $131.28 / $131.28 / $209.62	Facility		$131.28	$131.28	$209.62
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $90.87 / $90.87 / $90.87	Facility	26	$90.87	$90.87	$90.87
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $54.36 / $92.94 / $174.42	Professional		$54.36	$92.94	$174.42
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.25 / $37.77 / $72.01	Professional	26	$19.25	$37.77	$72.01
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.05 / $43.76 / $108.03	Professional	TC	$30.05	$43.76	$108.03
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $88.56 / $113.20 / $122.04	Professional		$88.56	$113.20	$122.04
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $40.98 / $66.00	Professional	26	$39.97	$40.98	$66.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $37.70 / $72.64 / $80.39	Professional	TC	$37.70	$72.64	$80.39
United Facility/Professional Professional Modifier Low / Median / High Price $70.72 / $121.32 / $181.98	Professional		$70.72	$121.32	$181.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.95 / $43.20 / $69.52	Professional	26	$24.95	$43.20	$69.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.22 / $78.12 / $126.04	Professional	TC	$41.22	$78.12	$126.04