Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.67 / $374.79 / $1,330.10	Facility		$119.67	$374.79	$1,330.10
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.71 / $22.59 / $44.72	Facility	26	$20.71	$22.59	$44.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $143.32 / $247.70 / $638.00	Facility	TC	$143.32	$247.70	$638.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.63 / $126.53 / $393.52	Professional		$23.63	$126.53	$393.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.14 / $28.34 / $92.00	Professional	26	$20.14	$28.34	$92.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.33 / $106.95 / $238.23	Professional	TC	$88.33	$106.95	$238.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $76.55 / $92.11 / $117.85	Professional		$76.55	$92.11	$117.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $19.20 / $34.35	Professional	26	$15.52	$19.20	$34.35
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $71.40 / $96.56 / $170.74	Professional	TC	$71.40	$96.56	$170.74
AmeriHealth Facility/Professional Facility Modifier Low / Median / High Price $453.79 / $946.96 / $6,250.77	Facility		$453.79	$946.96	$6,250.77
AmeriHealth Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $26.51 / $240.52	Professional	26	$22.09	$26.51	$240.52
Capital Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $348.58 / $5,000.00 / $77,850.02	Facility		$348.58	$5,000.00	$77,850.02
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $135.08 / $182.71 / $294.04	Professional		$135.08	$182.71	$294.04
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $24.76 / $34.22 / $52.76	Professional	26	$24.76	$34.22	$52.76
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $110.33 / $147.33 / $249.19	Professional	TC	$110.33	$147.33	$249.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $115.46 / $215.00 / $342.91	Facility		$115.46	$215.00	$342.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.06 / $176.89 / $275.56	Professional		$111.06	$176.89	$275.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.70 / $27.56 / $44.73	Professional	26	$19.70	$27.56	$44.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.82 / $150.05 / $237.79	Professional	TC	$92.82	$150.05	$237.79
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $146.76 / $184.94 / $374.26	Professional		$146.76	$184.94	$374.26
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $30.86 / $62.44	Professional	26	$25.00	$30.86	$62.44
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.81 / $154.09 / $311.81	Professional	TC	$120.81	$154.09	$311.81
Highmark BCBS Facility/Professional Facility Modifier Low / Median / High Price $127.74 / $278.98 / $646.46	Facility		$127.74	$278.98	$646.46
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $39.22 / $39.22 / $39.22	Facility	26	$39.22	$39.22	$39.22
Highmark BCBS Facility/Professional Facility Modifier TC Low / Median / High Price $197.42 / $381.78 / $636.30	Facility	TC	$197.42	$381.78	$636.30
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.72 / $139.25 / $155.31	Professional		$128.72	$139.25	$155.31
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.26 / $25.59 / $36.29	Professional	26	$23.26	$25.59	$36.29
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.87 / $141.63 / $173.02	Professional	TC	$121.87	$141.63	$173.02
Independence Blue Cross Facility/Professional Facility Modifier Low / Median / High Price $139.41 / $915.88 / $3,725.31	Facility		$139.41	$915.88	$3,725.31
Independence Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $20.82 / $27.00 / $44.21	Professional	26	$20.82	$27.00	$44.21
Martin's Point Facility/Professional Facility Modifier Low / Median / High Price $113.98 / $334.01 / $1,206.53	Facility		$113.98	$334.01	$1,206.53
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $20.71 / $26.92 / $70.25	Facility	26	$20.71	$26.92	$70.25
Martin's Point Facility/Professional Facility Modifier TC Low / Median / High Price $108.90 / $309.95 / $834.74	Facility	TC	$108.90	$309.95	$834.74
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $22.69 / $132.62 / $346.83	Professional		$22.69	$132.62	$346.83
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $20.28 / $30.49 / $86.40	Professional	26	$20.28	$30.49	$86.40
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $91.34 / $119.02 / $244.00	Professional	TC	$91.34	$119.02	$244.00
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,042.19 / $1,860.64 / $2,341.21	Facility		$1,042.19	$1,860.64	$2,341.21
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.81 / $165.00 / $258.60	Professional		$30.81	$165.00	$258.60
Priority Health Facility/Professional Facility Modifier Low / Median / High Price $106.70 / $214.07 / $342.91	Facility		$106.70	$214.07	$342.91
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $23.98 / $23.98 / $23.98	Facility	26	$23.98	$23.98	$23.98
Priority Health Facility/Professional Facility Modifier TC Low / Median / High Price $109.98 / $109.98 / $109.98	Facility	TC	$109.98	$109.98	$109.98
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $108.45 / $171.67 / $274.10	Professional		$108.45	$171.67	$274.10
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.70 / $27.56 / $46.74	Professional	26	$19.70	$27.56	$46.74
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.97 / $148.56 / $237.79	Professional	TC	$91.97	$148.56	$237.79
UPMC Health Plan Facility/Professional Facility Modifier Low / Median / High Price $114.15 / $114.15 / $180.00	Facility		$114.15	$114.15	$180.00
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $20.90 / $20.90 / $31.00	Facility	26	$20.90	$20.90	$31.00
UPMC Health Plan Facility/Professional Facility Modifier TC Low / Median / High Price $93.25 / $93.25 / $149.00	Facility	TC	$93.25	$93.25	$149.00
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.29 / $114.15 / $180.00	Professional		$112.29	$114.15	$180.00
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $20.26 / $21.02 / $31.00	Professional	26	$20.26	$21.02	$31.00
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $91.27 / $93.25 / $149.00	Professional	TC	$91.27	$93.25	$149.00
United Facility/Professional Professional Modifier Low / Median / High Price $111.51 / $146.66 / $246.06	Professional		$111.51	$146.66	$246.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $26.82 / $47.75	Professional	26	$19.89	$26.82	$47.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.77 / $122.59 / $204.31	Professional	TC	$91.77	$122.59	$204.31