Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.79 / $52.48 / $226.42	Facility	26	$45.79	$52.48	$226.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.00 / $128.97 / $424.45	Professional		$84.00	$128.97	$424.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.82 / $49.59 / $131.66	Professional	26	$40.82	$49.59	$131.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $172.62 / $314.29 / $598.30	Professional	50	$172.62	$314.29	$598.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.04 / $50.94 / $81.79	Professional	TC	$40.04	$50.94	$81.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.89 / $124.69 / $167.68	Professional		$82.89	$124.69	$167.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.49 / $66.92 / $83.82	Professional	26	$51.49	$66.92	$83.82
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $106.87 / $106.87 / $149.97	Professional		$106.87	$106.87	$149.97
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $91.15 / $137.88 / $168.30	Professional		$91.15	$137.88	$168.30
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $44.42 / $66.83 / $91.05	Professional	26	$44.42	$66.83	$91.05
Capital Blue Cross Facility/Professional Professional Modifier 50 Low / Median / High Price $182.30 / $275.80 / $336.61	Professional	50	$182.30	$275.80	$336.61
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $46.72 / $66.98 / $81.81	Professional	TC	$46.72	$66.98	$81.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.63 / $114.51 / $199.28	Professional		$84.63	$114.51	$199.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.09 / $58.94 / $100.82	Professional	26	$42.09	$58.94	$100.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.37 / $58.23 / $104.78	Professional	TC	$44.37	$58.23	$104.78
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $95.06 / $139.41 / $187.45	Professional		$95.06	$139.41	$187.45
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.70 / $64.56 / $87.53	Professional	26	$43.70	$64.56	$87.53
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.35 / $74.84 / $97.91	Professional	TC	$51.35	$74.84	$97.91
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.55 / $117.00 / $155.58	Professional		$100.55	$117.00	$155.58
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.29 / $65.45 / $112.13	Professional	26	$49.29	$65.45	$112.13
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $207.11 / $231.14 / $239.69	Professional	50	$207.11	$231.14	$239.69
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $106.87 / $119.69 / $205.02	Professional		$106.87	$119.69	$205.02
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $45.79 / $58.87 / $226.42	Facility	26	$45.79	$58.87	$226.42
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $85.99 / $151.41 / $432.00	Professional		$85.99	$151.41	$432.00
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $42.71 / $60.80 / $135.16	Professional	26	$42.71	$60.80	$135.16
Martin's Point Facility/Professional Professional Modifier 50 Low / Median / High Price $172.62 / $314.29 / $683.20	Professional	50	$172.62	$314.29	$683.20
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $41.32 / $57.21 / $120.65	Professional	TC	$41.32	$57.21	$120.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.70 / $82.05 / $166.31	Professional		$44.70	$82.05	$166.31
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $84.63 / $113.64 / $208.61	Professional		$84.63	$113.64	$208.61
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.30 / $58.94 / $107.29	Professional	26	$42.30	$58.94	$107.29
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.37 / $58.28 / $106.21	Professional	TC	$44.37	$58.28	$106.21
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $42.90 / $43.97 / $43.97	Facility	26	$42.90	$43.97	$43.97
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $92.68 / $93.92 / $100.80	Professional		$92.68	$93.92	$100.80
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.95 / $43.97 / $45.81	Professional	26	$42.95	$43.97	$45.81
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $48.83 / $49.95 / $54.99	Professional	TC	$48.83	$49.95	$54.99
United Facility/Professional Professional Modifier Low / Median / High Price $84.36 / $106.14 / $183.32	Professional		$84.36	$106.14	$183.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.91 / $55.54 / $88.48	Professional	26	$41.91	$55.54	$88.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.46 / $53.56 / $96.13	Professional	TC	$39.46	$53.56	$96.13