Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.06 / $111.57 / $561.23	Facility	26	$107.06	$111.57	$561.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.28 / $193.58 / $446.31	Professional		$162.28	$193.58	$446.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.25 / $105.91 / $226.71	Professional	26	$92.25	$105.91	$226.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.08 / $79.70 / $124.82	Professional	TC	$67.08	$79.70	$124.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $254.07 / $312.66	Professional		$160.34	$254.07	$312.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $119.63 / $158.49 / $194.74	Professional	26	$119.63	$158.49	$194.74
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $196.20 / $224.45 / $394.27	Professional		$196.20	$224.45	$394.27
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $169.96 / $277.64 / $353.21	Professional		$169.96	$277.64	$353.21
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $103.21 / $166.31 / $199.47	Professional	26	$103.21	$166.31	$199.47
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $66.75 / $111.33 / $157.25	Professional	TC	$66.75	$111.33	$157.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.05 / $216.46 / $396.01	Professional		$120.05	$216.46	$396.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.49 / $135.35 / $234.41	Professional	26	$98.49	$135.35	$234.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.65 / $102.43 / $169.71	Professional	TC	$66.65	$102.43	$169.71
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $175.10 / $257.14 / $346.20	Professional		$175.10	$257.14	$346.20
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.54 / $150.01 / $203.36	Professional	26	$101.54	$150.01	$203.36
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.56 / $107.14 / $139.72	Professional	TC	$73.56	$107.14	$139.72
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.53 / $201.64 / $258.32	Professional		$125.53	$201.64	$258.32
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.60 / $125.53 / $178.33	Professional	26	$111.60	$125.53	$178.33
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $196.20 / $219.74 / $394.27	Professional		$196.20	$219.74	$394.27
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $137.65 / $561.23	Facility	26	$101.96	$137.65	$561.23
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $168.07 / $227.00 / $525.92	Professional		$168.07	$227.00	$525.92
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $96.29 / $127.14 / $264.70	Professional	26	$96.29	$127.14	$264.70
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $68.20 / $87.67 / $163.25	Professional	TC	$68.20	$87.67	$163.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $80.86 / $163.52 / $311.54	Professional		$80.86	$163.52	$311.54
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $118.19 / $118.19 / $118.19	Facility	26	$118.19	$118.19	$118.19
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $116.06 / $216.46 / $400.45	Professional		$116.06	$216.46	$400.45
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $99.11 / $135.24 / $242.20	Professional	26	$99.11	$135.24	$242.20
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.65 / $102.20 / $178.15	Professional	TC	$66.65	$102.20	$178.15
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $94.01 / $101.53 / $101.53	Facility	26	$94.01	$101.53	$101.53
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $166.84 / $169.50 / $180.57	Professional		$166.84	$169.50	$180.57
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $99.24 / $101.53 / $105.74	Professional	26	$99.24	$101.53	$105.74
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $66.50 / $67.97 / $74.81	Professional	TC	$66.50	$67.97	$74.81
United Facility/Professional Professional Modifier Low / Median / High Price $160.34 / $210.46 / $370.39	Professional		$160.34	$210.46	$370.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $97.37 / $127.63 / $207.98	Professional	26	$97.37	$127.63	$207.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.98 / $93.10 / $159.21	Professional	TC	$68.98	$93.10	$159.21