Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $79.43 / $102.33	Facility	26	$58.88	$79.43	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $239.88 / $676.08	Professional		$131.83	$239.88	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $67.61 / $125.89	Professional	26	$42.66	$67.61	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $138.04 / $269.15	Professional	TC	$97.72	$138.04	$269.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $151.36 / $363.08	Professional		$117.49	$151.36	$363.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $50.12 / $91.20	Professional	26	$35.48	$50.12	$91.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $204.17 / $239.88	Professional	TC	$72.44	$204.17	$239.88
BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $288.40 / $302.00	Professional		$275.42	$288.40	$302.00
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $87.10 / $91.20	Professional	26	$83.18	$87.10	$91.20
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $204.17 / $213.80	Professional	TC	$190.55	$204.17	$213.80
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 $123.03 / $302.00 / $478.63	Professional		$123.03	$302.00	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $100.00 / $138.04	Professional	26	$38.02	$100.00	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $208.93 / $338.84	Professional	TC	$87.10	$208.93	$338.84
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 $190.55 / $281.84 / $457.09	Professional		$190.55	$281.84	$457.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $117.49	Professional	26	$58.88	$87.10	$117.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $724.44	Professional	TC	$131.83	$173.78	$724.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $338.84 / $537.03	Professional		$302.00	$338.84	$537.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $158.49	Professional	26	$91.20	$104.71	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $239.88 / $380.19	Professional	TC	$208.93	$239.88	$380.19
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 $302.00 / $354.81 / $537.03	Professional		$302.00	$354.81	$537.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $107.15 / $158.49	Professional	26	$91.20	$107.15	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $245.47 / $380.19	Professional	TC	$208.93	$245.47	$380.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $114.82 / $269.15	Professional		$48.98	$114.82	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $398.11	Professional		$190.55	$234.42	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $120.23	Professional	26	$56.23	$72.44	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $165.96 / $269.15	Professional	TC	$131.83	$165.96	$269.15