Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $46.77 / $74.13	Facility	26	$32.36	$46.77	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $257.04 / $602.56	Professional		$109.65	$257.04	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $54.95 / $141.25	Professional	26	$33.11	$54.95	$141.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $31.62 / $77.62 / $616.60	Professional	52	$31.62	$77.62	$616.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $407.38	Professional	TC	$79.43	$112.20	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $120.23 / $125.89	Facility	26	$117.49	$120.23	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $309.03 / $389.05	Professional		$162.18	$309.03	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $83.18 / $104.71	Professional	26	$43.65	$83.18	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $223.87 / $281.84	Professional	TC	$117.49	$223.87	$281.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $173.78 / $537.03	Professional		$125.89	$173.78	$537.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $125.89	Professional	26	$37.15	$54.95	$125.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $134.90 / $407.38	Professional	TC	$89.13	$134.90	$407.38
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $162.18 / $162.18	Facility	26	$120.23	$162.18	$162.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $245.47 / $831.76	Professional		$141.25	$245.47	$831.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $63.10 / $229.09	Professional	26	$40.74	$63.10	$229.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $125.89 / $602.56	Professional	TC	$93.33	$125.89	$602.56
Midlands Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $302.00 / $446.68	Professional		$251.19	$302.00	$446.68
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $125.89	Professional	26	$70.79	$89.13	$125.89
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $213.80 / $316.23	Professional	TC	$177.83	$213.80	$316.23
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $302.00 / $446.68	Professional		$263.03	$302.00	$446.68
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $125.89	Professional	26	$75.86	$85.11	$125.89
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $218.78 / $316.23	Professional	TC	$190.55	$218.78	$316.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $93.33 / $213.80	Professional		$36.31	$93.33	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $165.96 / $302.00	Professional		$128.82	$165.96	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $89.13	Professional	26	$37.15	$46.77	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $117.49 / $213.80	Professional	TC	$91.20	$117.49	$213.80
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $281.84	Professional		$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $77.62	Professional	26	$66.07	$66.07	$77.62
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $169.82 / $199.53	Professional	TC	$169.82	$169.82	$199.53