Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.42 / $53.42 / $371.58	Professional		$53.42	$53.42	$371.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $66.78 / $454.74	Professional	26	$17.69	$66.78	$454.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.72 / $35.72 / $124.84	Professional	TC	$35.72	$35.72	$124.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $180.15 / $180.15 / $180.15	Professional		$180.15	$180.15	$180.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $53.05 / $62.45	Professional	26	$12.81	$53.05	$62.45
BCBS Facility/Professional Facility Modifier Low / Median / High Price $128.09 / $128.09 / $128.09	Facility		$128.09	$128.09	$128.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $92.81 / $131.44 / $138.37	Professional		$92.81	$131.44	$138.37
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.68 / $40.60 / $42.75	Professional	26	$28.68	$40.60	$42.75
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $64.12 / $90.82 / $95.60	Professional	TC	$64.12	$90.82	$95.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.00 / $168.26 / $212.45	Professional		$127.00	$168.26	$212.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.00 / $52.88 / $62.75	Professional	26	$42.00	$52.88	$62.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.00 / $118.14 / $146.82	Professional	TC	$85.00	$118.14	$146.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $53.42 / $166.47 / $437.49	Facility		$53.42	$166.47	$437.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $124.11 / $124.11 / $124.11	Facility	26	$124.11	$124.11	$124.11
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $313.37 / $313.37 / $313.37	Facility	TC	$313.37	$313.37	$313.37
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.87 / $128.22 / $559.76	Professional		$61.87	$128.22	$559.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $50.38 / $65.83	Professional	26	$28.51	$50.38	$65.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $40.86 / $58.72 / $386.24	Professional	TC	$40.86	$58.72	$386.24
Midlands Facility/Professional Facility Modifier Low / Median / High Price $146.88 / $168.26 / $212.45	Facility		$146.88	$168.26	$212.45
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $53.19 / $53.19 / $53.19	Facility	26	$53.19	$53.19	$53.19
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $111.59 / $111.59 / $111.59	Facility	TC	$111.59	$111.59	$111.59
Midlands Facility/Professional Professional Modifier Low / Median / High Price $135.85 / $168.26 / $212.45	Professional		$135.85	$168.26	$212.45
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.30 / $101.83 / $177.54	Professional		$30.30	$101.83	$177.54
United Facility/Professional Professional Modifier Low / Median / High Price $61.87 / $87.23 / $169.54	Professional		$61.87	$87.23	$169.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.01 / $28.51 / $53.26	Professional	26	$21.01	$28.51	$53.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.86 / $58.72 / $116.28	Professional	TC	$40.86	$58.72	$116.28