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 $186.21 / $426.58 / $1,230.27	Professional		$186.21	$426.58	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $141.25 / $257.04	Professional	26	$64.57	$141.25	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $218.78 / $478.63	Professional	TC	$109.65	$218.78	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $162.18 / $426.58	Professional		$69.18	$162.18	$426.58
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $79.43 / $158.49	Professional	26	$53.70	$79.43	$158.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $141.25	Professional	TC	$63.10	$91.20	$141.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $354.81 / $389.05	Professional		$338.84	$354.81	$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 $208.93 / $229.09 / $309.03	Professional	TC	$208.93	$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 / $851.14	Professional		$186.21	$457.09	$851.14
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 / $707.95	Professional	TC	$120.23	$295.12	$707.95
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 / $489.78 / $3,162.28	Professional		$245.47	$489.78	$3,162.28
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $602.56	Professional	26	$87.10	$134.90	$602.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $316.23 / $2,754.23	Professional	TC	$158.49	$316.23	$2,754.23
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 / $1,000.00	Professional		$426.58	$660.69	$1,000.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $154.88 / $234.42	Professional	26	$147.91	$154.88	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $416.87 / $831.76	Professional	TC	$275.42	$416.87	$831.76
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 / $467.74	Professional	TC	$144.54	$257.04	$467.74