Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $52.48 / $162.18	Facility	26	$35.48	$52.48	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $1,047.13	Professional		$169.82	$263.03	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $141.25	Professional	26	$33.88	$42.66	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $190.55 / $588.84	Professional	TC	$138.04	$190.55	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $407.38 / $645.65	Professional		$208.93	$407.38	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $77.62 / $107.15	Professional	26	$36.31	$77.62	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $562.34	Professional	TC	$177.83	$331.13	$562.34
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $371.54 / $676.08	Professional		$169.82	$371.54	$676.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $151.36	Professional	26	$38.02	$57.54	$151.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $275.42 / $575.44	Professional	TC	$138.04	$275.42	$575.44
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $208.93 / $208.93 / $208.93	Facility	26	$208.93	$208.93	$208.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $380.19 / $1,584.89	Professional		$218.78	$380.19	$1,584.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $426.58	Professional	26	$38.90	$69.18	$426.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $302.00 / $1,412.54	Professional	TC	$169.82	$302.00	$1,412.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $457.09 / $501.19	Professional		$371.54	$457.09	$501.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $109.65	Professional	26	$69.18	$87.10	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $363.08 / $398.11	Professional	TC	$281.84	$363.08	$398.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $457.09 / $537.03	Professional		$407.38	$457.09	$537.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $102.33 / $109.65	Professional	26	$52.48	$102.33	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $398.11 / $426.58	Professional	TC	$309.03	$398.11	$426.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $177.83 / $380.19	Professional		$40.74	$177.83	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $323.59 / $524.81	Professional		$204.17	$323.59	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $61.66 / $104.71	Professional	26	$38.90	$61.66	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $269.15 / $426.58	Professional	TC	$162.18	$269.15	$426.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $407.38	Professional		$346.74	$346.74	$407.38
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $81.28	Professional	26	$69.18	$69.18	$81.28
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $275.42 / $323.59	Professional	TC	$275.42	$275.42	$323.59