Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.45 / $19.85 / $31.01	Facility	26	$17.45	$19.85	$31.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.01 / $86.39 / $205.00	Professional		$48.01	$86.39	$205.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $24.06 / $72.00	Professional	26	$16.48	$24.06	$72.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.82 / $41.07 / $94.20	Professional	TC	$30.82	$41.07	$94.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $47.25 / $47.25 / $48.55	Professional		$47.25	$47.25	$48.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.47 / $25.23 / $32.97	Professional	26	$14.47	$25.23	$32.97
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $66.27 / $69.65 / $71.22	Professional		$66.27	$69.65	$71.22
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $22.51 / $22.51 / $22.51	Professional	26	$22.51	$22.51	$22.51
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $48.62 / $79.59 / $162.16	Professional		$48.62	$79.59	$162.16
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $17.48 / $28.32 / $43.82	Professional	26	$17.48	$28.32	$43.82
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $31.14 / $51.25 / $123.94	Professional	TC	$31.14	$51.25	$123.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.46 / $81.30 / $137.38	Professional		$50.46	$81.30	$137.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $23.94 / $38.44	Professional	26	$16.98	$23.94	$38.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.42 / $54.71 / $97.84	Professional	TC	$33.42	$54.71	$97.84
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $64.45 / $84.71 / $156.22	Professional		$64.45	$84.71	$156.22
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.87 / $25.39 / $51.38	Professional	26	$20.87	$25.39	$51.38
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.51 / $51.82 / $104.86	Professional	TC	$40.51	$51.82	$104.86
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.70 / $21.81 / $22.67	Professional	26	$21.70	$21.81	$22.67
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $69.65 / $110.17	Professional		$66.95	$69.65	$110.17
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $22.51 / $37.11 / $37.11	Professional	26	$22.51	$37.11	$37.11
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $17.45 / $24.89 / $99.05	Facility	26	$17.45	$24.89	$99.05
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $50.48 / $90.63 / $204.33	Professional		$50.48	$90.63	$204.33
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $16.62 / $27.59 / $69.00	Professional	26	$16.62	$27.59	$69.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $30.83 / $47.00 / $119.30	Professional	TC	$30.83	$47.00	$119.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.40 / $80.04 / $129.91	Professional		$28.40	$80.04	$129.91
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $20.10 / $20.10 / $20.10	Facility	26	$20.10	$20.10	$20.10
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $49.99 / $76.84 / $135.13	Professional		$49.99	$76.84	$135.13
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $23.72 / $40.72	Professional	26	$16.98	$23.72	$40.72
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.65 / $50.89 / $97.84	Professional	TC	$32.65	$50.89	$97.84
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $17.29 / $17.29 / $21.11	Facility	26	$17.29	$17.29	$21.11
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $47.90 / $48.59 / $82.25	Professional		$47.90	$48.59	$82.25
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.89 / $17.29 / $21.11	Professional	26	$16.89	$17.29	$21.11
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $30.65 / $31.29 / $61.14	Professional	TC	$30.65	$31.29	$61.14
United Facility/Professional Professional Modifier Low / Median / High Price $51.94 / $78.63 / $110.95	Professional		$51.94	$78.63	$110.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.14 / $23.44 / $36.65	Professional	26	$17.14	$23.44	$36.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.47 / $48.45 / $79.47	Professional	TC	$33.47	$48.45	$79.47