Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.43 / $40.94 / $67.33	Facility	26	$37.43	$40.94	$67.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.63 / $229.55 / $645.00	Professional		$175.63	$229.55	$645.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $40.24 / $83.29	Professional	26	$29.75	$40.24	$83.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.35 / $169.16 / $282.39	Professional	TC	$136.35	$169.16	$282.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.78 / $139.16 / $277.36	Professional		$121.78	$139.16	$277.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $36.52 / $62.11	Professional	26	$28.51	$36.52	$62.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.87 / $219.63 / $263.11	Professional	TC	$109.87	$219.63	$263.11
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $209.85 / $219.42 / $490.87	Professional		$209.85	$219.42	$490.87
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $39.39 / $43.63 / $79.64	Professional	26	$39.39	$43.63	$79.64
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $180.62 / $305.27 / $463.38	Professional		$180.62	$305.27	$463.38
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $37.60 / $61.39 / $77.06	Professional	26	$37.60	$61.39	$77.06
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $143.03 / $241.61 / $382.38	Professional	TC	$143.03	$241.61	$382.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.85 / $270.20 / $426.78	Professional		$177.85	$270.20	$426.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $42.65 / $72.00	Professional	26	$30.61	$42.65	$72.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.56 / $232.96 / $364.59	Professional	TC	$145.56	$232.96	$364.59
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $161.05 / $232.87 / $494.60	Professional		$161.05	$232.87	$494.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.22 / $56.00 / $113.33	Professional	26	$45.22	$56.00	$113.33
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $237.44 / $480.49	Professional	TC	$186.21	$237.44	$480.49
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $52.63 / $52.63 / $52.63	Facility	26	$52.63	$52.63	$52.63
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $197.69 / $234.82 / $246.56	Professional		$197.69	$234.82	$246.56
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.86 / $45.48 / $54.81	Professional	26	$40.86	$45.48	$54.81
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.41 / $223.34 / $268.01	Professional	TC	$162.41	$223.34	$268.01
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $191.03 / $218.70 / $415.44	Professional		$191.03	$218.70	$415.44
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $39.39 / $43.63 / $79.92	Professional	26	$39.39	$43.63	$79.92
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $37.42 / $48.65 / $127.32	Facility	26	$37.42	$48.65	$127.32
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $179.25 / $263.67 / $596.00	Professional		$179.25	$263.67	$596.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $32.24 / $46.78 / $87.16	Professional	26	$32.24	$46.78	$87.16
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $142.59 / $183.48 / $435.70	Professional	TC	$142.59	$183.48	$435.70
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.81 / $223.40 / $414.30	Professional		$54.81	$223.40	$414.30
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $43.27 / $43.27 / $43.27	Facility	26	$43.27	$43.27	$43.27
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $177.85 / $267.14 / $426.78	Professional		$177.85	$267.14	$426.78
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.86 / $43.06 / $72.00	Professional	26	$30.86	$43.06	$72.00
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.56 / $226.40 / $365.43	Professional	TC	$145.56	$226.40	$365.43
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $37.47 / $37.47 / $43.00	Facility	26	$37.47	$37.47	$43.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $180.03 / $182.88 / $327.00	Professional		$180.03	$182.88	$327.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $36.35 / $37.67 / $43.00	Professional	26	$36.35	$37.67	$43.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $142.37 / $145.40 / $284.00	Professional	TC	$142.37	$145.40	$284.00
United Facility/Professional Professional Modifier Low / Median / High Price $174.61 / $240.37 / $406.54	Professional		$174.61	$240.37	$406.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.02 / $42.08 / $76.63	Professional	26	$29.02	$42.08	$76.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.90 / $192.98 / $325.83	Professional	TC	$144.90	$192.98	$325.83