Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.24 / $83.47 / $226.08	Facility	26	$26.24	$83.47	$226.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.24 / $87.92 / $378.75	Professional		$53.24	$87.92	$378.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.67 / $57.49 / $144.00	Professional	26	$23.67	$57.49	$144.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.62 / $61.01 / $444.97	Professional	52	$26.62	$61.01	$444.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.01 / $55.88 / $285.98	Professional	TC	$27.01	$55.88	$285.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.61 / $100.61 / $127.68	Professional		$100.61	$100.61	$127.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.02 / $51.79 / $60.96	Professional	26	$28.02	$51.79	$60.96
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.70 / $56.70 / $56.70	Professional	TC	$56.70	$56.70	$56.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.18 / $106.02 / $108.67	Professional		$98.18	$106.02	$108.67
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.11 / $50.88 / $52.34	Professional	26	$47.11	$50.88	$52.34
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.07 / $54.59 / $56.52	Professional	TC	$51.07	$54.59	$56.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $150.12 / $150.12 / $150.12	Facility	26	$150.12	$150.12	$150.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.80 / $124.87 / $198.38	Professional		$74.80	$124.87	$198.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.93 / $60.22 / $76.59	Professional	26	$21.93	$60.22	$76.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.57 / $67.72 / $135.46	Professional	TC	$50.57	$67.72	$135.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $122.62 / $122.62 / $122.62	Facility	26	$122.62	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $117.00 / $447.95	Professional		$89.02	$117.00	$447.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.04 / $49.31 / $265.83	Professional	26	$33.04	$49.31	$265.83
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $56.48 / $56.48 / $56.48	Professional	52	$56.48	$56.48	$56.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $55.24 / $69.09 / $398.99	Professional	TC	$55.24	$69.09	$398.99
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $84.28 / $86.74 / $150.12	Facility	26	$84.28	$86.74	$150.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.43 / $149.00 / $198.38	Professional		$107.43	$149.00	$198.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.46 / $52.87 / $129.80	Professional		$27.46	$52.87	$129.80
United Facility/Professional Professional Modifier Low / Median / High Price $89.02 / $117.39 / $180.33	Professional		$89.02	$117.39	$180.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.78 / $54.25 / $68.43	Professional	26	$33.78	$54.25	$68.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.24 / $69.09 / $111.90	Professional	TC	$55.24	$69.09	$111.90