Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $60.26 / $123.03	Facility	26	$52.48	$60.26	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $398.11 / $1,621.81	Professional		$218.78	$398.11	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $120.23 / $354.81	Professional	26	$57.54	$120.23	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $302.00 / $630.96	Professional	TC	$162.18	$302.00	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $186.21 / $190.55	Facility	26	$181.97	$186.21	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $602.56 / $812.83	Professional		$363.08	$602.56	$812.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $131.83 / $169.82	Professional	26	$74.13	$131.83	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $489.78 / $691.83	Professional	TC	$281.84	$489.78	$691.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $1,584.89	Professional		$194.98	$380.19	$1,584.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $251.19	Professional	26	$52.48	$95.50	$251.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $275.42 / $1,380.38	Professional	TC	$144.54	$275.42	$1,380.38
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $407.38 / $524.81 / $524.81	Facility	26	$407.38	$524.81	$524.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $549.54 / $2,951.21	Professional		$251.19	$549.54	$2,951.21
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $501.19	Professional	26	$58.88	$83.18	$501.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $416.87 / $2,630.27	Professional	TC	$177.83	$416.87	$2,630.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $676.08 / $912.01	Professional		$436.52	$676.08	$912.01
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $199.53	Professional	26	$114.82	$138.04	$199.53
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $512.86 / $776.25	Professional	TC	$316.23	$512.86	$776.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $549.54 / $912.01	Professional		$512.86	$549.54	$912.01
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $173.78	Professional	26	$104.71	$131.83	$173.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $426.58 / $812.83	Professional	TC	$380.19	$426.58	$812.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $165.96 / $363.08	Professional		$57.54	$165.96	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $346.74 / $660.69	Professional		$229.09	$346.74	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $70.79 / $158.49	Professional	26	$58.88	$70.79	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $263.03 / $549.54	Professional	TC	$169.82	$263.03	$549.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $575.44	Professional		$489.78	$489.78	$575.44
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $125.89 / $147.91	Professional	26	$125.89	$125.89	$147.91
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $426.58	Professional	TC	$363.08	$363.08	$426.58