Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.26 / $515.85 / $1,026.96	Facility		$102.26	$515.85	$1,026.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.49 / $83.46 / $303.27	Facility	26	$33.49	$83.46	$303.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $82.53 / $404.41 / $863.97	Facility	TC	$82.53	$404.41	$863.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.51 / $243.46 / $587.92	Professional		$97.51	$243.46	$587.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.04 / $58.81 / $146.34	Professional	26	$32.04	$58.81	$146.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $48.76 / $51.13 / $328.05	Professional	52	$48.76	$51.13	$328.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.75 / $87.95 / $189.14	Professional	TC	$66.75	$87.95	$189.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $108.20 / $199.96 / $235.38	Professional		$108.20	$199.96	$235.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $61.52 / $67.06	Professional	26	$33.72	$61.52	$67.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.31 / $133.63 / $133.63	Professional	TC	$72.31	$133.63	$133.63
BCBS Facility/Professional Facility Modifier Low / Median / High Price $370.81 / $502.54 / $943.40	Facility		$370.81	$502.54	$943.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $185.63 / $200.46 / $205.47	Professional		$185.63	$200.46	$205.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.06 / $65.93 / $67.59	Professional	26	$61.06	$65.93	$67.59
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $124.58 / $134.52 / $137.88	Professional	TC	$124.58	$134.52	$137.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.07 / $591.54 / $600.00	Facility		$85.07	$591.54	$600.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $194.64 / $194.64 / $194.64	Facility	26	$194.64	$194.64	$194.64
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $396.96 / $396.96 / $396.96	Facility	TC	$396.96	$396.96	$396.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.82 / $234.31 / $315.13	Professional		$94.82	$234.31	$315.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.63 / $76.87 / $98.90	Professional	26	$28.63	$76.87	$98.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.87 / $157.44 / $216.23	Professional	TC	$62.87	$157.44	$216.23
Medica Facility/Professional Facility Modifier Low / Median / High Price $117.60 / $271.08 / $963.68	Facility		$117.60	$271.08	$963.68
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $157.44 / $157.44 / $157.44	Facility	26	$157.44	$157.44	$157.44
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $331.53 / $627.90 / $949.44	Facility	TC	$331.53	$627.90	$949.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $127.40 / $207.03 / $704.47	Professional		$127.40	$207.03	$704.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $43.03 / $64.88 / $103.35	Professional	26	$43.03	$64.88	$103.35
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $89.27 / $137.10 / $483.33	Professional	TC	$89.27	$137.10	$483.33
Midlands Facility/Professional Facility Modifier Low / Median / High Price $99.24 / $229.86 / $397.67	Facility		$99.24	$229.86	$397.67
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $113.98 / $117.30 / $194.64	Facility	26	$113.98	$117.30	$194.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $129.12 / $321.85 / $396.96	Facility	TC	$129.12	$321.85	$396.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $203.00 / $234.31 / $290.26	Professional		$203.00	$234.31	$290.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.49 / $108.95 / $197.06	Professional		$37.49	$108.95	$197.06
United Facility/Professional Facility Modifier Low / Median / High Price $110.06 / $197.98 / $277.98	Facility		$110.06	$197.98	$277.98
United Facility/Professional Professional Modifier Low / Median / High Price $127.40 / $169.87 / $258.10	Professional		$127.40	$169.87	$258.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.03 / $69.09 / $87.18	Professional	26	$43.03	$69.09	$87.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.37 / $137.10 / $175.78	Professional	TC	$84.37	$137.10	$175.78