Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $151.36 / $549.54	Facility	26	$87.10	$151.36	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $660.69	Professional		$194.98	$380.19	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $123.03 / $239.88	Professional	26	$67.61	$123.03	$239.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	52	$123.03	$123.03	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $281.84 / $478.63	Professional	TC	$109.65	$281.84	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $173.78 / $426.58	Professional		$138.04	$173.78	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $147.91	Professional	26	$52.48	$72.44	$147.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $91.20 / $218.78	Professional	TC	$81.28	$91.20	$218.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $363.08 / $389.05	Professional		$338.84	$363.08	$389.05
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $131.83 / $141.25	Professional	26	$123.03	$131.83	$141.25
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $229.09 / $309.03	Professional	TC	$213.80	$229.09	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $457.09 / $831.76	Professional		$186.21	$457.09	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $147.91 / $204.17	Professional	26	$64.57	$147.91	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $295.12 / $645.65	Professional	TC	$120.23	$295.12	$645.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $436.52 / $2,884.03	Professional		$245.47	$436.52	$2,884.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $208.93	Professional	26	$87.10	$134.90	$208.93
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $288.40 / $2,511.89	Professional	TC	$158.49	$288.40	$2,511.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $426.58 / $660.69	Professional		$371.54	$426.58	$660.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $154.88 / $234.42	Professional	26	$134.90	$154.88	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $275.42 / $416.87	Professional	TC	$234.42	$275.42	$416.87
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $660.69 / $912.01	Professional		$426.58	$660.69	$912.01
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $154.88 / $234.42	Professional	26	$144.54	$154.88	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $416.87 / $758.58	Professional	TC	$275.42	$416.87	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $147.91 / $323.59	Professional		$70.79	$147.91	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $407.38 / $645.65	Professional		$223.87	$407.38	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $131.83 / $181.97	Professional	26	$75.86	$131.83	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $257.04 / $457.09	Professional	TC	$144.54	$257.04	$457.09