Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $132.94 / $138.38 / $191.28	Facility	26	$132.94	$138.38	$191.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.07 / $233.86 / $541.00	Professional		$198.07	$233.86	$541.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.39 / $131.58 / $296.14	Professional	26	$117.39	$131.58	$296.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.20 / $92.39 / $143.44	Professional	TC	$76.20	$92.39	$143.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.70 / $308.24 / $375.77	Professional		$192.70	$308.24	$375.77
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $125.28 / $194.30 / $243.28	Professional	26	$125.28	$194.30	$243.28
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $235.11 / $268.97 / $469.27	Professional		$235.11	$268.97	$469.27
Capital Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $204.26 / $318.95 / $421.83	Professional		$204.26	$318.95	$421.83
Capital Blue Cross Facility/Professional Professional Modifier 26 Low / Median / High Price $128.94 / $192.55 / $249.13	Professional	26	$128.94	$192.55	$249.13
Capital Blue Cross Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $127.89 / $177.36	Professional	TC	$75.31	$127.89	$177.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.48 / $261.12 / $474.30	Professional		$123.48	$261.12	$474.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.04 / $168.93 / $292.50	Professional	26	$123.04	$168.93	$292.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.06 / $117.85 / $195.04	Professional	TC	$76.06	$117.85	$195.04
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $210.10 / $308.54 / $415.36	Professional		$210.10	$308.54	$415.36
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $127.09 / $187.65 / $254.16	Professional	26	$127.09	$187.65	$254.16
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.00 / $120.89 / $157.72	Professional	TC	$83.00	$120.89	$157.72
Highmark BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.82 / $243.09 / $345.57	Professional		$213.82	$243.09	$345.57
Highmark BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.58 / $158.03 / $215.33	Professional	26	$138.58	$158.03	$215.33
Highmark BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $257.14 / $257.14 / $257.14	Professional	50	$257.14	$257.14	$257.14
Independence Blue Cross Facility/Professional Professional Modifier Low / Median / High Price $235.11 / $268.97 / $469.27	Professional		$235.11	$268.97	$469.27
Martin's Point Facility/Professional Facility Modifier 26 Low / Median / High Price $126.62 / $154.33 / $191.28	Facility	26	$126.62	$154.33	$191.28
Martin's Point Facility/Professional Professional Modifier Low / Median / High Price $203.03 / $279.31 / $587.53	Professional		$203.03	$279.31	$587.53
Martin's Point Facility/Professional Professional Modifier 26 Low / Median / High Price $120.35 / $152.53 / $334.57	Professional	26	$120.35	$152.53	$334.57
Martin's Point Facility/Professional Professional Modifier TC Low / Median / High Price $78.39 / $100.72 / $187.61	Professional	TC	$78.39	$100.72	$187.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $90.12 / $202.20 / $374.28	Professional		$90.12	$202.20	$374.28
Priority Health Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Priority Health Facility/Professional Professional Modifier Low / Median / High Price $116.06 / $260.14 / $481.33	Professional		$116.06	$260.14	$481.33
Priority Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.81 / $168.93 / $302.50	Professional	26	$123.81	$168.93	$302.50
Priority Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.48 / $117.11 / $206.96	Professional	TC	$75.48	$117.11	$206.96
UPMC Health Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $117.41 / $126.68 / $126.68	Facility	26	$117.41	$126.68	$126.68
UPMC Health Plan Facility/Professional Professional Modifier Low / Median / High Price $201.49 / $204.76 / $217.88	Professional		$201.49	$204.76	$217.88
UPMC Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $123.82 / $126.68 / $131.91	Professional	26	$123.82	$126.68	$131.91
UPMC Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $76.39 / $78.08 / $85.96	Professional	TC	$76.39	$78.08	$85.96
United Facility/Professional Professional Modifier Low / Median / High Price $200.45 / $260.76 / $432.27	Professional		$200.45	$260.76	$432.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $119.79 / $151.58 / $251.83	Professional	26	$119.79	$151.58	$251.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.08 / $107.71 / $181.39	Professional	TC	$78.08	$107.71	$181.39