Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $169.82 / $489.78	Facility	26	$87.10	$169.82	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $691.83	Professional		$123.03	$173.78	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $93.33 / $239.88	Professional	26	$56.23	$93.33	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $87.10 / $177.83	Professional	TC	$64.57	$87.10	$177.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Professional		$239.88	$239.88	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $97.72 / $154.88	Professional	26	$52.48	$97.72	$154.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $251.19 / $263.03	Professional		$239.88	$251.19	$263.03
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $125.89 / $131.83	Professional	26	$120.23	$125.89	$131.83
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $125.89 / $131.83	Professional	TC	$120.23	$125.89	$131.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $269.15 / $389.05	Professional		$112.20	$269.15	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $112.20 / $199.53	Professional	26	$56.23	$112.20	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $138.04 / $194.98	Professional	TC	$56.23	$138.04	$194.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $1,412.54	Professional		$169.82	$275.42	$1,412.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $131.83 / $436.52	Professional	26	$67.61	$131.83	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $141.25 / $1,148.15	Professional	TC	$85.11	$141.25	$1,148.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $309.03 / $426.58	Professional		$263.03	$309.03	$426.58
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $151.36 / $234.42	Professional	26	$131.83	$151.36	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $154.88 / $194.98	Professional	TC	$123.03	$154.88	$194.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $346.74 / $660.69	Professional		$281.84	$346.74	$660.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $112.20 / $234.42	Professional	26	$107.15	$112.20	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $194.98 / $549.54	Professional	TC	$125.89	$194.98	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $114.82 / $251.19	Professional		$54.95	$114.82	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $263.03 / $354.81	Professional		$158.49	$263.03	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $158.49	Professional	26	$64.57	$114.82	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $138.04 / $194.98	Professional	TC	$77.62	$138.04	$194.98