Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $14.13 / $14.45	Facility	26	$14.13	$14.13	$14.45
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.90 / $102.33 / $218.78	Facility	TC	$30.90	$102.33	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $42.66 / $181.97	Professional		$38.02	$42.66	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.14 / $38.02	Professional	26	$12.88	$15.14	$38.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $28.84 / $75.86	Professional	TC	$23.44	$28.84	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $33.88 / $33.88	Professional		$33.88	$33.88	$33.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $22.91 / $22.91	Professional	TC	$22.91	$22.91	$22.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $83.18 / $87.10	Professional		$77.62	$83.18	$87.10
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $27.54 / $29.51	Professional	26	$25.70	$27.54	$29.51
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $54.95 / $58.88	Professional	TC	$51.29	$54.95	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	TC	$169.82	$169.82	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $87.10 / $134.90	Professional		$35.48	$87.10	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $31.62 / $42.66	Professional	26	$12.02	$31.62	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $57.54 / $93.33	Professional	TC	$23.99	$57.54	$93.33
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	26	$70.79	$70.79	$70.79
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $141.25 / $141.25 / $141.25	Facility	TC	$141.25	$141.25	$141.25
Medica Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $295.12	Professional		$47.86	$67.61	$295.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $93.33	Professional	26	$19.05	$25.70	$93.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $41.69 / $204.17	Professional	TC	$30.20	$41.69	$204.17
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $97.72 / $154.88	Professional		$87.10	$97.72	$154.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $33.11 / $50.12	Professional	26	$28.18	$33.11	$50.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $66.07 / $104.71	Professional	TC	$57.54	$66.07	$104.71
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	TC	$169.82	$169.82	$169.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $102.33 / $154.88	Professional		$87.10	$102.33	$154.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $33.11 / $50.12	Professional	26	$28.18	$33.11	$50.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $69.18 / $104.71	Professional	TC	$58.88	$69.18	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $33.11 / $77.62	Professional		$15.49	$33.11	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $66.07 / $104.71	Professional		$43.65	$66.07	$104.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.12 / $39.81	Professional	26	$16.60	$25.12	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $64.57	Professional	TC	$27.54	$38.90	$64.57