Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $64.57 / $81.28	Facility	26	$43.65	$64.57	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $218.78 / $501.19	Professional		$112.20	$218.78	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $64.57 / $114.82	Professional	26	$33.11	$64.57	$114.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $40.74 / $562.34	Professional	52	$31.62	$40.74	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $112.20 / $218.78	Professional	TC	$83.18	$112.20	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $117.49 / $229.09	Professional		$83.18	$117.49	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $37.15 / $69.18	Professional	26	$26.92	$37.15	$69.18
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.99 / $23.99 / $74.13	Professional	52	$23.99	$23.99	$74.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $141.25 / $173.78	Professional	TC	$58.88	$141.25	$173.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $234.42 / $245.47	Professional		$223.87	$234.42	$245.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $67.61 / $69.18	Professional	26	$63.10	$67.61	$69.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $165.96 / $173.78	Professional	TC	$158.49	$165.96	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	26	$199.53	$199.53	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $239.88 / $389.05	Professional		$100.00	$239.88	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $75.86 / $104.71	Professional	26	$29.51	$75.86	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $173.78 / $281.84	Professional	TC	$72.44	$173.78	$281.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $239.88 / $354.81	Professional		$162.18	$239.88	$354.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $69.18 / $87.10	Professional	26	$47.86	$69.18	$87.10
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	52	$117.49	$117.49	$117.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $151.36 / $602.56	Professional	TC	$109.65	$151.36	$602.56
Midlands Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $275.42 / $436.52	Professional		$239.88	$275.42	$436.52
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $123.03	Professional	26	$69.18	$79.43	$123.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $194.98 / $316.23	Professional	TC	$173.78	$194.98	$316.23
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	26	$199.53	$199.53	$199.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $288.40 / $436.52	Professional		$239.88	$288.40	$436.52
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $123.03	Professional	26	$69.18	$81.28	$123.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $204.17 / $316.23	Professional	TC	$173.78	$204.17	$316.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $93.33 / $213.80	Professional		$36.31	$93.33	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $186.21 / $316.23	Professional		$154.88	$186.21	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $93.33	Professional	26	$42.66	$56.23	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $134.90 / $223.87	Professional	TC	$109.65	$134.90	$223.87