Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.32 / $138.94 / $333.77	Facility	26	$126.32	$138.94	$333.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $593.96 / $753.06 / $1,414.12	Professional		$593.96	$753.06	$1,414.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.86 / $138.75 / $453.38	Professional	26	$116.86	$138.75	$453.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $286.48 / $319.66 / $467.76	Professional	52	$286.48	$319.66	$467.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $476.14 / $584.38 / $991.78	Professional	TC	$476.14	$584.38	$991.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $137.46 / $172.02 / $229.36	Professional	26	$137.46	$172.02	$229.36
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $668.45 / $975.69 / $1,901.73	Professional		$668.45	$975.69	$1,901.73
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $128.44 / $196.24 / $443.65	Professional	26	$128.44	$196.24	$443.65
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $540.01 / $774.28 / $1,458.10	Professional	TC	$540.01	$774.28	$1,458.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $610.17 / $921.45 / $1,464.44	Professional		$610.17	$921.45	$1,464.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.10 / $182.65 / $301.49	Professional	26	$117.10	$182.65	$301.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $492.48 / $746.55 / $1,181.94	Professional	TC	$492.48	$746.55	$1,181.94
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $683.37 / $997.15 / $1,317.60	Professional		$683.37	$997.15	$1,317.60
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $136.10 / $174.99 / $248.92	Professional	26	$136.10	$174.99	$248.92
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $565.05 / $822.16 / $1,068.68	Professional	TC	$565.05	$822.16	$1,068.68
Highmark BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $368.00 / $368.00 / $368.00	Facility	26	$368.00	$368.00	$368.00
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $142.46 / $728.00 / $921.62	Professional		$142.46	$728.00	$921.62
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.29 / $148.88 / $228.09	Professional	26	$134.29	$148.88	$228.09
Highmark BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $561.26 / $593.71 / $593.71	Professional	TC	$561.26	$593.71	$593.71
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $126.31 / $173.16 / $333.77	Facility	26	$126.31	$173.16	$333.77
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $632.40 / $821.92 / $2,053.66	Professional		$632.40	$821.92	$2,053.66
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $119.81 / $173.16 / $440.48	Professional	26	$119.81	$173.16	$440.48
Martin's Point Facility/Professional Professional Modifier 52 Low / Median / High Price $286.14 / $319.77 / $567.59	Professional	52	$286.14	$319.77	$567.59
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $506.85 / $673.69 / $1,323.90	Professional	TC	$506.85	$673.69	$1,323.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $129.44 / $786.20 / $1,282.88	Professional		$129.44	$786.20	$1,282.88
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $139.38 / $139.38 / $139.38	Facility	26	$139.38	$139.38	$139.38
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $610.17 / $902.86 / $1,474.42	Professional		$610.17	$902.86	$1,474.42
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.10 / $175.75 / $310.22	Professional	26	$117.10	$175.75	$310.22
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $492.48 / $719.82 / $1,193.48	Professional	TC	$492.48	$719.82	$1,193.48
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $119.63 / $119.63 / $213.75	Facility	26	$119.63	$119.63	$213.75
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $596.02 / $606.05 / $659.44	Professional		$596.02	$606.05	$659.44
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $116.74 / $119.63 / $123.86	Professional	26	$116.74	$119.63	$123.86
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $476.50 / $486.43 / $535.58	Professional	TC	$476.50	$486.43	$535.58
United Facility/Professional Professional Modifier Low / Median / High Price $591.87 / $792.17 / $1,249.47	Professional		$591.87	$792.17	$1,249.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $113.44 / $156.60 / $250.84	Professional	26	$113.44	$156.60	$250.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $463.52 / $628.28 / $1,028.00	Professional	TC	$463.52	$628.28	$1,028.00