Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $81.28 / $251.19	Professional		$53.70	$81.28	$251.19
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.84 / $112.20	Professional	26	$21.88	$28.84	$112.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	50	$389.05	$389.05	$389.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $204.17 / $245.47 / $269.15	Professional	52	$204.17	$245.47	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $34.67 / $63.10	Professional	TC	$26.92	$34.67	$63.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $64.57 / $104.71	Professional		$57.54	$64.57	$104.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $51.29	Professional	26	$43.65	$43.65	$51.29
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $81.28 / $117.49	Professional		$61.66	$81.28	$117.49
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.20 / $52.48	Professional	26	$26.30	$30.20	$52.48
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $64.57	Professional	TC	$34.67	$45.71	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Facility		$97.72	$97.72	$97.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.46 / $30.20 / $42.66	Facility	26	$6.46	$30.20	$42.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $74.13 / $117.49	Professional		$48.98	$74.13	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.84 / $48.98	Professional	26	$20.89	$28.84	$48.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $44.67 / $69.18	Professional	TC	$27.54	$44.67	$69.18
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $83.18 / $131.83	Professional		$56.23	$83.18	$131.83
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $37.15 / $56.23	Professional	26	$30.90	$37.15	$56.23
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $51.29 / $77.62	Professional	TC	$44.67	$51.29	$77.62
Geisinger Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $72.44 / $131.83	Professional		$58.88	$72.44	$131.83
Geisinger Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $28.18 / $54.95	Professional	26	$24.55	$28.18	$54.95
Geisinger Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $44.67 / $75.86	Professional	TC	$34.67	$44.67	$75.86
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $77.62 / $77.62	Professional		$72.44	$77.62	$77.62
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $32.36 / $44.67	Professional	26	$31.62	$32.36	$44.67
Highmark BCBS Facility/Professional Professional Modifier 52 Low / Median / High Price $36.31 / $38.02 / $38.90	Professional	52	$36.31	$38.02	$38.90
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $77.62	Professional	TC	$44.67	$44.67	$77.62
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $131.83	Professional		$66.07	$66.07	$131.83
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $77.62 / $194.98	Professional		$53.70	$77.62	$194.98
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $89.13	Professional	26	$21.88	$28.18	$89.13
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	50	$389.05	$389.05	$389.05
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $204.17 / $245.47 / $269.15	Professional	52	$204.17	$245.47	$269.15
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.02 / $77.62	Professional	TC	$28.84	$38.02	$77.62
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $114.82	Professional		$75.86	$75.86	$114.82
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $52.48 / $102.33	Professional		$19.95	$52.48	$102.33
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $26.92 / $26.92	Professional	26	$25.70	$26.92	$26.92
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $34.67 / $44.67	Professional	TC	$33.11	$34.67	$44.67
United Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $371.54 / $371.54	Facility		$371.54	$371.54	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $64.57 / $97.72	Professional		$44.67	$64.57	$97.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $26.30 / $41.69	Professional	26	$17.78	$26.30	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $57.54	Professional	TC	$25.70	$36.31	$57.54