Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $75.86 / $134.90	Facility	26	$60.26	$75.86	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $416.87 / $1,698.24	Professional		$97.72	$416.87	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $138.04 / $512.86	Professional	26	$61.66	$138.04	$512.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $263.03 / $1,096.48 / $1,778.28	Professional	50	$263.03	$1,096.48	$1,778.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $501.19 / $501.19 / $1,023.29	Professional	52	$501.19	$501.19	$1,023.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $338.84 / $1,023.29	Professional	TC	$141.25	$338.84	$1,023.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $213.80 / $223.87	Facility	26	$208.93	$213.80	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $562.34 / $831.76	Professional		$338.84	$562.34	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $147.91 / $190.55	Professional	26	$83.18	$147.91	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $389.05 / $707.95	Professional	TC	$234.42	$389.05	$707.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $354.81 / $1,659.59	Professional		$186.21	$354.81	$1,659.59
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $104.71 / $257.04	Professional	26	$60.26	$104.71	$257.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $245.47 / $1,412.54	Professional	TC	$125.89	$245.47	$1,412.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $602.56 / $602.56	Facility	26	$467.74	$602.56	$602.56
Medica Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $512.86 / $2,818.38	Professional		$257.04	$512.86	$2,818.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $112.20 / $524.81	Professional	26	$67.61	$112.20	$524.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $389.05 / $2,454.71	Professional	TC	$162.18	$389.05	$2,454.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $645.65 / $933.25	Professional		$407.38	$645.65	$933.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $158.49 / $223.87	Professional	26	$128.82	$158.49	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $446.68 / $776.25	Professional	TC	$281.84	$446.68	$776.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $223.87 / $223.87 / $223.87	Facility	26	$223.87	$223.87	$223.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $489.78 / $933.25	Professional		$457.09	$489.78	$933.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $141.25 / $194.98	Professional	26	$123.03	$141.25	$194.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $338.84 / $776.25	Professional	TC	$323.59	$338.84	$776.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $144.54 / $346.74	Professional		$66.07	$144.54	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $371.54 / $707.95	Professional		$229.09	$371.54	$707.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $93.33 / $194.98	Professional	26	$66.07	$93.33	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $489.78	Professional	TC	$162.18	$257.04	$489.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $537.03	Professional		$457.09	$457.09	$537.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $141.25 / $165.96	Professional	26	$141.25	$141.25	$165.96
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $371.54	Professional	TC	$316.23	$316.23	$371.54