Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $100.00 / $436.52	Facility	26	$56.23	$100.00	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $190.55 / $562.34	Professional		$104.71	$190.55	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $93.33 / $199.53	Professional	26	$42.66	$93.33	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $87.10 / $239.88	Professional	TC	$61.66	$87.10	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $128.82 / $234.42	Professional		$83.18	$128.82	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $61.66 / $100.00	Professional	26	$36.31	$61.66	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $53.70 / $109.65	Professional	TC	$41.69	$53.70	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $213.80 / $229.09	Professional		$204.17	$213.80	$229.09
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $87.10 / $93.33	Professional	26	$81.28	$87.10	$93.33
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $125.89 / $154.88	Professional	TC	$112.20	$125.89	$154.88
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 $91.20 / $223.87 / $346.74	Professional		$91.20	$223.87	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $97.72 / $138.04	Professional	26	$38.02	$97.72	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $144.54 / $208.93	Professional	TC	$53.70	$144.54	$208.93
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $213.80 / $363.08	Professional		$138.04	$213.80	$363.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $309.03	Professional	26	$57.54	$91.20	$309.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $467.74	Professional	TC	$79.43	$109.65	$467.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $251.19 / $398.11	Professional		$223.87	$251.19	$398.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $102.33 / $158.49	Professional	26	$91.20	$102.33	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $151.36 / $234.42	Professional	TC	$131.83	$151.36	$234.42
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 $173.78 / $223.87 / $275.42	Professional		$173.78	$223.87	$275.42
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $112.20	Professional	26	$70.79	$81.28	$112.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $144.54 / $162.18	Professional	TC	$102.33	$144.54	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $104.71 / $229.09	Professional		$47.86	$104.71	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $281.84	Professional		$134.90	$173.78	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $117.49	Professional	26	$54.95	$72.44	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $165.96	Professional	TC	$79.43	$104.71	$165.96