Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.39 / $70.65 / $86.24	Facility	26	$45.39	$70.65	$86.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.03 / $253.61 / $718.40	Professional		$138.03	$253.61	$718.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.39 / $88.55 / $123.75	Professional	26	$45.39	$88.55	$123.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.12 / $147.55 / $296.19	Professional	TC	$103.12	$147.55	$296.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.03 / $159.47 / $346.95	Professional		$121.03	$159.47	$346.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.63 / $84.67 / $105.80	Professional	26	$48.63	$84.67	$105.80
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $197.94 / $204.87 / $204.87	Professional	TC	$197.94	$204.87	$204.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $274.36 / $293.25 / $302.50	Professional		$274.36	$293.25	$302.50
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.23 / $88.95 / $91.18	Professional	26	$83.23	$88.95	$91.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $191.13 / $204.30 / $212.08	Professional	TC	$191.13	$204.30	$212.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $262.50 / $262.50 / $262.50	Facility	26	$262.50	$262.50	$262.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.91 / $340.50 / $465.42	Professional		$171.91	$340.50	$465.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.44 / $104.44 / $133.81	Professional	26	$54.44	$104.44	$133.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.22 / $238.39 / $331.61	Professional	TC	$128.22	$238.39	$331.61
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $211.96 / $211.96 / $211.96	Facility	26	$211.96	$211.96	$211.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $205.49 / $307.62 / $1,024.30	Professional		$205.49	$307.62	$1,024.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.35 / $91.57 / $135.66	Professional	26	$63.35	$91.57	$135.66
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $142.13 / $213.21 / $724.19	Professional	TC	$142.13	$213.21	$724.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $159.12 / $163.76 / $262.50	Facility	26	$159.12	$163.76	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $290.10 / $340.50 / $537.78	Professional		$290.10	$340.50	$537.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.52 / $142.21 / $264.02	Professional		$47.52	$142.21	$264.02
United Facility/Professional Professional Modifier Low / Median / High Price $205.49 / $304.60 / $395.18	Professional		$205.49	$304.60	$395.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.35 / $95.02 / $119.58	Professional	26	$63.35	$95.02	$119.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.13 / $210.70 / $268.32	Professional	TC	$142.13	$210.70	$268.32