Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $141.25 / $147.91	Facility	26	$63.10	$141.25	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $457.09 / $1,819.70	Professional		$208.93	$457.09	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $141.25 / $371.54	Professional	26	$69.18	$141.25	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $281.84 / $616.60	Professional	TC	$131.83	$281.84	$616.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $223.87 / $229.09	Facility	26	$218.78	$223.87	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $549.54 / $851.14	Professional		$323.59	$549.54	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $158.49 / $204.17	Professional	26	$91.20	$158.49	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $380.19 / $691.83	Professional	TC	$239.88	$380.19	$691.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $1,621.81	Professional		$177.83	$346.74	$1,621.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $371.54	Professional	26	$64.57	$114.82	$371.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $223.87 / $1,258.93	Professional	TC	$114.82	$223.87	$1,258.93
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $645.65 / $645.65	Facility	26	$501.19	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $549.54 / $2,818.38	Professional		$251.19	$549.54	$2,818.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $107.15 / $575.44	Professional	26	$70.79	$107.15	$575.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $389.05 / $2,454.71	Professional	TC	$158.49	$389.05	$2,454.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $616.60 / $933.25	Professional		$398.11	$616.60	$933.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $165.96 / $213.80	Professional	26	$138.04	$165.96	$213.80
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $416.87 / $776.25	Professional	TC	$257.04	$416.87	$776.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $575.44 / $933.25	Professional		$467.74	$575.44	$933.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $162.18 / $229.09	Professional	26	$125.89	$162.18	$229.09
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $426.58 / $776.25	Professional	TC	$302.00	$426.58	$776.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $144.54 / $331.13	Professional		$69.18	$144.54	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $363.08 / $691.83	Professional		$229.09	$363.08	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $100.00 / $213.80	Professional	26	$70.79	$100.00	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $245.47 / $478.63	Professional	TC	$154.88	$245.47	$478.63
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $446.68 / $524.81	Professional		$446.68	$446.68	$524.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $151.36 / $177.83	Professional	26	$151.36	$151.36	$177.83
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $338.84	Professional	TC	$288.40	$288.40	$338.84