Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $97.72 / $371.54	Facility	26	$58.88	$97.72	$371.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $245.47 / $831.76	Professional		$117.49	$245.47	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $147.91	Professional	26	$42.66	$63.10	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $131.83 / $288.40	Professional	TC	$77.62	$131.83	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $107.15 / $288.40	Professional		$93.33	$107.15	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $91.20	Professional	26	$35.48	$48.98	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	TC	$190.55	$190.55	$190.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $245.47 / $257.04	Professional		$229.09	$245.47	$257.04
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $87.10 / $93.33	Professional	26	$83.18	$87.10	$93.33
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $151.36 / $223.87	Professional	TC	$112.20	$151.36	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Facility	26	$263.03	$263.03	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $309.03 / $446.68	Professional		$151.36	$309.03	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $97.72 / $138.04	Professional	26	$43.65	$97.72	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $194.98 / $338.84	Professional	TC	$97.72	$194.98	$338.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $295.12 / $1,621.81	Professional		$173.78	$295.12	$1,621.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $89.13 / $165.96	Professional	26	$58.88	$89.13	$165.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $213.80 / $1,348.96	Professional	TC	$114.82	$213.80	$1,348.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $288.40 / $446.68	Professional		$251.19	$288.40	$446.68
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $158.49	Professional	26	$91.20	$104.71	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $181.97 / $288.40	Professional	TC	$162.18	$181.97	$288.40
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Facility	26	$263.03	$263.03	$263.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $446.68 / $512.86	Professional		$288.40	$446.68	$512.86
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $107.15 / $158.49	Professional	26	$97.72	$107.15	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $288.40 / $398.11	Professional	TC	$181.97	$288.40	$398.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $102.33 / $223.87	Professional		$48.98	$102.33	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $275.42 / $426.58	Professional		$158.49	$275.42	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $89.13 / $125.89	Professional	26	$51.29	$89.13	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $177.83 / $251.19	Professional	TC	$107.15	$177.83	$251.19