Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $91.20 / $131.83	Facility	26	$57.54	$91.20	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $281.84	Professional		$114.82	$151.36	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $45.71 / $91.20	Professional	26	$38.02	$45.71	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $190.55	Professional	TC	$77.62	$107.15	$190.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $199.53 / $281.84	Professional		$123.03	$199.53	$281.84
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $66.07 / $89.13	Professional	26	$39.81	$66.07	$89.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $134.90 / $190.55	Professional	TC	$83.18	$134.90	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $288.40 / $371.54	Professional		$128.82	$288.40	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $91.20 / $120.23	Professional	26	$41.69	$91.20	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $204.17 / $257.04	Professional	TC	$87.10	$204.17	$257.04
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 $173.78 / $263.03 / $1,096.48	Professional		$173.78	$263.03	$1,096.48
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $446.68	Professional	26	$53.70	$85.11	$446.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $177.83 / $870.96	Professional	TC	$114.82	$177.83	$870.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $275.42 / $354.81	Professional		$269.15	$275.42	$354.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $93.33 / $117.49	Professional	26	$85.11	$93.33	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $177.83 / $234.42	Professional	TC	$169.82	$177.83	$234.42
Midlands Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $302.00 / $316.23	Professional		$288.40	$302.00	$316.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $100.00	Professional	26	$75.86	$97.72	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $213.80 / $213.80	Professional	TC	$204.17	$213.80	$213.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $263.03 / $380.19	Professional		$229.09	$263.03	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $245.47 / $338.84	Professional		$158.49	$245.47	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $109.65	Professional	26	$47.86	$79.43	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $169.82 / $234.42	Professional	TC	$102.33	$169.82	$234.42