Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $117.49 / $128.82	Facility	26	$60.26	$117.49	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $1,096.48	Professional		$169.82	$275.42	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $91.20 / $281.84	Professional	26	$54.95	$91.20	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $371.54	Professional	TC	$114.82	$190.55	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $194.98 / $199.53	Facility	26	$190.55	$194.98	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $575.44	Professional		$251.19	$426.58	$575.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $141.25 / $173.78	Professional	26	$79.43	$141.25	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $288.40 / $398.11	Professional	TC	$173.78	$288.40	$398.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $302.00 / $1,071.52	Professional		$158.49	$302.00	$1,071.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $100.00 / $309.03	Professional	26	$56.23	$100.00	$309.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $199.53 / $776.25	Professional	TC	$104.71	$199.53	$776.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $436.52 / $562.34 / $562.34	Facility	26	$436.52	$562.34	$562.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $371.54 / $1,905.46	Professional		$194.98	$371.54	$1,905.46
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $436.52	Professional	26	$61.66	$93.33	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $234.42 / $1,584.89	Professional	TC	$123.03	$234.42	$1,584.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $489.78 / $691.83	Professional		$346.74	$489.78	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $147.91 / $186.21	Professional	26	$120.23	$147.91	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $331.13 / $575.44	Professional	TC	$229.09	$331.13	$575.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	26	$199.53	$199.53	$199.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $416.87 / $691.83	Professional		$371.54	$416.87	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $208.93	Professional	26	$112.20	$141.25	$208.93
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $275.42 / $575.44	Professional	TC	$245.47	$275.42	$575.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $128.82 / $295.12	Professional		$60.26	$128.82	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $269.15 / $467.74	Professional		$186.21	$269.15	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $77.62 / $158.49	Professional	26	$61.66	$77.62	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $181.97 / $302.00	Professional	TC	$123.03	$181.97	$302.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $338.84 / $398.11	Professional		$338.84	$338.84	$398.11
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $134.90	Professional	26	$114.82	$114.82	$134.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $263.03	Professional	TC	$223.87	$223.87	$263.03