Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $455.64 / $1,069.00 / $2,701.83	Facility		$455.64	$1,069.00	$2,701.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.48 / $77.59 / $118.62	Facility	26	$62.48	$77.59	$118.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.61 / $291.23 / $762.84	Professional		$183.61	$291.23	$762.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.45 / $77.89 / $242.86	Professional	26	$63.45	$77.89	$242.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $118.79 / $175.12 / $330.62	Professional	TC	$118.79	$175.12	$330.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $142.13 / $246.00 / $355.32	Professional		$142.13	$246.00	$355.32
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.08 / $98.01 / $128.04	Professional	26	$54.08	$98.01	$128.04
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $92.60 / $92.60 / $184.97	Professional	TC	$92.60	$92.60	$184.97
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $925.04 / $1,930.34 / $12,816.64	Facility		$925.04	$1,930.34	$12,816.64
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $255.76 / $271.41 / $327.07	Professional		$255.76	$271.41	$327.07
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $88.31 / $97.10	Professional	26	$80.70	$88.31	$97.10
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 $188.32 / $276.31 / $417.60	Professional		$188.32	$276.31	$417.60
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $67.86 / $98.73 / $133.28	Professional	26	$67.86	$98.73	$133.28
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $120.46 / $178.08 / $296.00	Professional	TC	$120.46	$178.08	$296.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $219.59 / $257.97 / $527.48	Facility		$219.59	$257.97	$527.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.29 / $293.91 / $465.09	Professional		$185.29	$293.91	$465.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.33 / $90.39 / $146.88	Professional	26	$66.33	$90.39	$146.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $130.69 / $209.24 / $346.07	Professional	TC	$130.69	$209.24	$346.07
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $239.17 / $294.33 / $604.86	Professional		$239.17	$294.33	$604.86
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.09 / $98.77 / $199.88	Professional	26	$81.09	$98.77	$199.88
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $156.78 / $196.65 / $404.97	Professional	TC	$156.78	$196.65	$404.97
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $627.98 / $1,188.23 / $2,122.16	Facility		$627.98	$1,188.23	$2,122.16
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $103.20 / $103.20 / $158.00	Facility	26	$103.20	$103.20	$158.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $217.82 / $230.42 / $314.99	Professional		$217.82	$230.42	$314.99
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.79 / $78.06 / $115.96	Professional	26	$75.79	$78.06	$115.96
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $734.78 / $1,866.98 / $7,638.41	Facility		$734.78	$1,866.98	$7,638.41
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $255.76 / $272.72 / $426.82	Professional		$255.76	$272.72	$426.82
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $80.70 / $90.07 / $144.25	Professional	26	$80.70	$90.07	$144.25
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $447.02 / $1,119.33 / $2,888.76	Facility		$447.02	$1,119.33	$2,888.76
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $64.81 / $84.26 / $153.62	Facility	26	$64.81	$84.26	$153.62
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $183.61 / $332.07 / $734.26	Professional		$183.61	$332.07	$734.26
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $64.02 / $87.48 / $230.44	Professional	26	$64.02	$87.48	$230.44
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $118.79 / $181.74 / $410.02	Professional	TC	$118.79	$181.74	$410.02
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $824.94 / $870.12 / $1,163.58	Facility		$824.94	$870.12	$1,163.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $105.43 / $301.00 / $401.60	Professional		$105.43	$301.00	$401.60
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $219.59 / $219.59 / $527.48	Facility		$219.59	$219.59	$527.48
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $185.29 / $292.75 / $474.61	Professional		$185.29	$292.75	$474.61
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.33 / $89.03 / $149.91	Professional	26	$66.33	$89.03	$149.91
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.69 / $202.96 / $346.22	Professional	TC	$130.69	$202.96	$346.22
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $188.52 / $188.52 / $304.00	Facility		$188.52	$188.52	$304.00
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $66.83 / $66.83 / $73.64	Facility	26	$66.83	$66.83	$73.64
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $185.87 / $188.52 / $304.00	Professional		$185.87	$188.52	$304.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $65.30 / $66.83 / $73.64	Professional	26	$65.30	$66.83	$73.64
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $119.19 / $121.69 / $230.36	Professional	TC	$119.19	$121.69	$230.36
United Facility/Professional Professional Modifier Low / Median / High Price $201.63 / $282.27 / $422.40	Professional		$201.63	$282.27	$422.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.40 / $88.55 / $145.69	Professional	26	$69.40	$88.55	$145.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $127.84 / $186.74 / $296.32	Professional	TC	$127.84	$186.74	$296.32