Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.79 / $101.61 / $287.52	Facility	26	$31.79	$101.61	$287.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.63 / $224.31 / $396.00	Professional		$112.63	$224.31	$396.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $69.56 / $142.00	Professional	26	$31.55	$69.56	$142.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $56.32 / $73.73 / $136.30	Professional	52	$56.32	$73.73	$136.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.97 / $94.62 / $219.00	Professional	TC	$77.97	$94.62	$219.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.73 / $218.53 / $257.23	Professional		$89.73	$218.53	$257.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.83 / $43.67 / $73.90	Professional	26	$28.83	$43.67	$73.90
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $22.43 / $22.43 / $22.43	Professional	52	$22.43	$22.43	$22.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.38 / $155.75 / $155.75	Professional	TC	$132.38	$155.75	$155.75
BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.03 / $220.31 / $225.83	Professional		$204.03	$220.31	$225.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.22 / $61.79 / $63.57	Professional	26	$57.22	$61.79	$63.57
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.80 / $158.52 / $162.47	Professional	TC	$146.80	$158.52	$162.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $182.40 / $182.40 / $182.40	Facility	26	$182.40	$182.40	$182.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.75 / $258.06 / $346.16	Professional		$92.75	$258.06	$346.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $72.28 / $94.05	Professional	26	$30.12	$72.28	$94.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.31 / $185.78 / $252.10	Professional	TC	$72.31	$185.78	$252.10
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $148.36 / $148.36 / $148.36	Facility	26	$148.36	$148.36	$148.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $134.15 / $216.47 / $339.23	Professional		$134.15	$216.47	$339.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $61.69 / $96.87	Professional	26	$40.47	$61.69	$96.87
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $108.24 / $108.24 / $108.24	Professional	52	$108.24	$108.24	$108.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $91.39 / $155.37 / $570.15	Professional	TC	$91.39	$155.37	$570.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $104.77 / $107.82 / $182.40	Facility	26	$104.77	$107.82	$182.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.00 / $251.20 / $313.20	Professional		$169.00	$251.20	$313.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.49 / $113.03 / $197.40	Professional		$35.49	$113.03	$197.40
United Facility/Professional Professional Modifier Low / Median / High Price $126.08 / $212.22 / $280.02	Professional		$126.08	$212.22	$280.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $63.73 / $82.00	Professional	26	$40.47	$63.73	$82.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.39 / $156.97 / $198.03	Professional	TC	$91.39	$156.97	$198.03