Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $272.64 / $334.47 / $508.39	Facility	26	$272.64	$334.47	$508.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $990.38 / $1,133.92 / $1,812.39	Professional		$990.38	$1,133.92	$1,812.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $272.64 / $342.52 / $1,279.31	Professional	26	$272.64	$342.52	$1,279.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $717.74 / $809.36 / $1,292.44	Professional	TC	$717.74	$809.36	$1,292.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $270.77 / $270.77 / $480.41	Professional	26	$270.77	$270.77	$480.41
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $303.82 / $303.82 / $316.08	Professional	26	$303.82	$303.82	$316.08
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $846.93 / $1,632.44 / $2,146.69	Professional		$846.93	$1,632.44	$2,146.69
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $252.85 / $484.53 / $672.46	Professional	26	$252.85	$484.53	$672.46
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $594.08 / $1,170.34 / $1,474.25	Professional	TC	$594.08	$1,170.34	$1,474.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,079.44 / $1,393.98 / $2,112.79	Professional		$1,079.44	$1,393.98	$2,112.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $297.47 / $412.95 / $598.04	Professional	26	$297.47	$412.95	$598.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $762.46 / $963.12 / $1,514.74	Professional	TC	$762.46	$963.12	$1,514.74
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $1,512.59 / $1,512.59 / $1,565.44	Professional		$1,512.59	$1,512.59	$1,565.44
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $412.37 / $412.37 / $450.21	Professional	26	$412.37	$412.37	$450.21
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,100.23 / $1,100.23 / $1,115.24	Professional	TC	$1,100.23	$1,100.23	$1,115.24
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $303.82 / $303.82 / $316.08	Professional	26	$303.82	$303.82	$316.08
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $272.63 / $395.32 / $662.25	Facility	26	$272.63	$395.32	$662.25
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $990.37 / $1,268.27 / $3,766.76	Professional		$990.37	$1,268.27	$3,766.76
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $272.63 / $388.02 / $913.00	Professional	26	$272.63	$388.02	$913.00
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $717.74 / $857.38 / $1,620.54	Professional	TC	$717.74	$857.38	$1,620.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,224.30 / $1,420.70 / $2,912.40	Professional		$1,224.30	$1,420.70	$2,912.40
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $1,086.97 / $1,405.40 / $2,310.51	Professional		$1,086.97	$1,405.40	$2,310.51
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $310.99 / $428.23 / $646.22	Professional	26	$310.99	$428.23	$646.22
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $765.95 / $973.01 / $1,626.30	Professional	TC	$765.95	$973.01	$1,626.30
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $282.10 / $282.10 / $298.75	Facility	26	$282.10	$282.10	$298.75
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $953.69 / $996.60 / $1,080.86	Professional		$953.69	$996.60	$1,080.86
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $270.83 / $286.20 / $298.75	Professional	26	$270.83	$286.20	$298.75
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $654.94 / $714.50 / $786.52	Professional	TC	$654.94	$714.50	$786.52
United Facility/Professional Professional Modifier Low / Median / High Price $1,062.77 / $1,349.15 / $2,102.79	Professional		$1,062.77	$1,349.15	$2,102.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $296.66 / $413.37 / $625.88	Professional	26	$296.66	$413.37	$625.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $762.46 / $976.10 / $1,458.89	Professional	TC	$762.46	$976.10	$1,458.89