Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $52.48 / $114.82	Facility	26	$50.12	$52.48	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $234.42 / $602.56	Professional		$147.91	$234.42	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $204.17	Professional	26	$51.29	$74.13	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $144.54 / $363.08	Professional	TC	$93.33	$144.54	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $173.78 / $177.83	Facility	26	$165.96	$173.78	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $489.78	Professional		$218.78	$363.08	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $125.89 / $154.88	Professional	26	$69.18	$125.89	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $239.88 / $338.84	Professional	TC	$158.49	$239.88	$338.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $831.76	Professional		$138.04	$263.03	$831.76
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $89.13 / $398.11	Professional	26	$50.12	$89.13	$398.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $165.96 / $549.54	Professional	TC	$87.10	$165.96	$549.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $501.19 / $501.19	Facility	26	$389.05	$501.19	$501.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $309.03 / $1,548.82	Professional		$169.82	$309.03	$1,548.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $83.18 / $363.08	Professional	26	$54.95	$83.18	$363.08
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $194.98 / $1,258.93	Professional	TC	$102.33	$194.98	$1,258.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $416.87 / $562.34	Professional		$295.12	$416.87	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $123.03 / $165.96	Professional	26	$107.15	$123.03	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $269.15 / $457.09	Professional	TC	$190.55	$269.15	$457.09
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $354.81 / $562.34	Professional		$316.23	$354.81	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $125.89 / $186.21	Professional	26	$97.72	$125.89	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $229.09 / $457.09	Professional	TC	$199.53	$229.09	$457.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $114.82 / $251.19	Professional		$54.95	$114.82	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $229.09 / $398.11	Professional		$158.49	$229.09	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $69.18 / $141.25	Professional	26	$54.95	$69.18	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $151.36 / $251.19	Professional	TC	$102.33	$151.36	$251.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $338.84	Professional		$288.40	$288.40	$338.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $102.33 / $120.23	Professional	26	$102.33	$102.33	$120.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $186.21 / $218.78	Professional	TC	$186.21	$186.21	$218.78