Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $154.88	Facility	26	$154.88	$154.88	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $416.87 / $851.14	Professional		$338.84	$416.87	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $120.23 / $263.03	Professional	26	$97.72	$120.23	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $295.12 / $602.56	Professional	TC	$239.88	$295.12	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $831.76 / $1,023.29	Professional		$794.33	$831.76	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $251.19 / $302.00	Professional	26	$239.88	$251.19	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $588.84 / $724.44	Professional	TC	$549.54	$588.84	$724.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $549.54 / $851.14	Professional		$295.12	$549.54	$851.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $158.49 / $302.00	Professional	26	$104.71	$158.49	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $346.74 / $478.63	Professional	TC	$229.09	$346.74	$478.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $478.63 / $478.63 / $478.63	Facility	26	$478.63	$478.63	$478.63
Medica Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $676.08 / $1,148.15	Professional		$371.54	$676.08	$1,148.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $186.21 / $794.33	Professional	26	$120.23	$186.21	$794.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $346.74 / $1,905.46	Professional	TC	$223.87	$346.74	$1,905.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $758.58 / $977.24	Professional		$512.86	$758.58	$977.24
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $251.19 / $371.54	Professional	26	$194.98	$251.19	$371.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $512.86 / $707.95	Professional	TC	$316.23	$512.86	$707.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $977.24 / $977.24	Professional		$616.60	$977.24	$977.24
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $281.84 / $281.84	Professional	26	$204.17	$281.84	$281.84
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $707.95 / $707.95	Professional	TC	$407.38	$707.95	$707.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.02 / $645.65 / $1,000.00	Professional		$3.02	$645.65	$1,000.00
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $524.81 / $1,023.29	Professional		$354.81	$524.81	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $181.97 / $338.84	Professional	26	$114.82	$181.97	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $354.81 / $691.83	Professional	TC	$234.42	$354.81	$691.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $776.25	Professional		$660.69	$660.69	$776.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $199.53 / $234.42	Professional	26	$199.53	$199.53	$234.42
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $457.09 / $537.03	Professional	TC	$457.09	$457.09	$537.03