Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.48 / $161.22 / $524.79	Facility		$84.48	$161.22	$524.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.57 / $19.85 / $58.95	Facility	26	$18.57	$19.85	$58.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $127.57 / $200.59 / $357.73	Facility	TC	$127.57	$200.59	$357.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.50 / $71.97 / $140.07	Professional		$35.50	$71.97	$140.07
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.57 / $24.48 / $58.45	Professional	26	$18.57	$24.48	$58.45
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $288.89	Professional	50	$234.74	$234.74	$288.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.37 / $18.04 / $42.55	Professional	52	$15.37	$18.04	$42.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.02 / $49.11 / $104.01	Professional	TC	$14.02	$49.11	$104.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.64 / $34.57 / $41.48	Professional		$33.64	$34.57	$41.48
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.91 / $23.91 / $23.91	Professional	TC	$23.91	$23.91	$23.91
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $62.11 / $64.62 / $65.26	Professional		$62.11	$64.62	$65.26
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $5,000.00 / $8,639.91 / $79,506.39	Facility		$5,000.00	$8,639.91	$79,506.39
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $38.00 / $61.53 / $125.92	Professional		$38.00	$61.53	$125.92
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $21.54 / $33.58 / $54.13	Professional	26	$21.54	$33.58	$54.13
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $16.45 / $27.07 / $83.69	Professional	TC	$16.45	$27.07	$83.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $41.38	Facility		$41.38	$41.38	$41.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.35	Facility	26	$23.35	$23.35	$23.35
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $18.64	Facility	TC	$18.64	$18.64	$18.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.46 / $73.58 / $123.01	Professional		$33.46	$73.58	$123.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.42 / $26.87 / $43.82	Professional	26	$17.42	$26.87	$43.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.66 / $49.85 / $83.68	Professional	TC	$14.66	$49.85	$83.68
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $42.53 / $55.09 / $205.73	Professional		$42.53	$55.09	$205.73
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.95 / $29.51 / $41.90	Professional	26	$22.95	$29.51	$41.90
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.34 / $25.16 / $32.47	Professional	TC	$19.34	$25.16	$32.47
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $82.98 / $315.88 / $578.65	Facility		$82.98	$315.88	$578.65
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $184.45 / $184.45 / $184.45	Facility	TC	$184.45	$184.45	$184.45
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $175.50 / $175.50 / $180.38	Professional		$175.50	$175.50	$180.38
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.59 / $33.59 / $33.59	Professional	26	$33.59	$33.59	$33.59
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $62.11 / $64.62 / $65.26	Professional		$62.11	$64.62	$65.26
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $84.48 / $357.73 / $571.42	Facility		$84.48	$357.73	$571.42
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $19.85 / $19.85 / $58.95	Facility	26	$19.85	$19.85	$58.95
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $48.20 / $189.02 / $357.73	Facility	TC	$48.20	$189.02	$357.73
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $36.08 / $71.97 / $150.47	Professional		$36.08	$71.97	$150.47
Martin's Point Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $19.23 / $28.18 / $58.95	Professional	26	$19.23	$28.18	$58.95
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $281.35 / $435.00	Professional	50	$234.74	$281.35	$435.00
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $15.48 / $19.79 / $120.52	Professional	52	$15.48	$19.79	$120.52
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $15.25 / $37.51 / $104.01	Professional	TC	$15.25	$37.51	$104.01
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $209.76 / $216.75 / $283.33	Facility		$209.76	$216.75	$283.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.42 / $47.50 / $87.22	Professional		$23.42	$47.50	$87.22
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $41.38 / $41.38 / $76.81	Facility		$41.38	$41.38	$76.81
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $23.35 / $23.35 / $23.91	Facility	26	$23.35	$23.35	$23.91
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $18.64 / $18.64 / $52.91	Facility	TC	$18.64	$18.64	$52.91
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $33.46 / $74.84 / $123.01	Professional		$33.46	$74.84	$123.01
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.41 / $26.98 / $45.17	Professional	26	$17.41	$26.98	$45.17
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.66 / $49.71 / $83.68	Professional	TC	$14.66	$49.71	$83.68
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $35.97 / $35.97 / $77.00	Facility		$35.97	$35.97	$77.00
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $20.50 / $20.50 / $24.00	Facility	26	$20.50	$20.50	$24.00
UPMC Health Plan Facility/Professional Facility Modifier TC Low / Median / High Price $15.48 / $15.48 / $53.00	Facility	TC	$15.48	$15.48	$53.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $35.43 / $35.97 / $77.00	Professional		$35.43	$35.97	$77.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $20.07 / $20.50 / $24.00	Professional	26	$20.07	$20.50	$24.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.19 / $15.48 / $53.00	Professional	TC	$15.19	$15.48	$53.00
United Facility/Professional Professional Modifier Low / Median / High Price $41.68 / $55.39 / $95.34	Professional		$41.68	$55.39	$95.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.80 / $24.16 / $39.81	Professional	26	$19.80	$24.16	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.97 / $27.90 / $61.44	Professional	TC	$19.97	$27.90	$61.44