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 / $134.90	Facility	26	$50.12	$52.48	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $275.42 / $831.76	Professional		$177.83	$275.42	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $93.33 / $245.47	Professional	26	$53.70	$93.33	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $208.93 / $489.78	Professional	TC	$123.03	$208.93	$489.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $213.80 / $218.78	Facility	26	$204.17	$213.80	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $467.74 / $616.60	Professional		$295.12	$467.74	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $169.82	Professional	26	$70.79	$125.89	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $346.74 / $446.68	Professional	TC	$213.80	$346.74	$446.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $316.23 / $1,023.29	Professional		$165.96	$316.23	$1,023.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $95.50 / $239.88	Professional	26	$50.12	$95.50	$239.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $223.87 / $831.76	Professional	TC	$114.82	$223.87	$831.76
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 $229.09 / $407.38 / $1,949.84	Professional		$229.09	$407.38	$1,949.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $562.34	Professional	26	$57.54	$91.20	$562.34
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $281.84 / $1,548.82	Professional	TC	$169.82	$281.84	$1,548.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $512.86 / $660.69	Professional		$363.08	$512.86	$660.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $131.83 / $181.97	Professional	26	$107.15	$131.83	$181.97
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $363.08 / $524.81	Professional	TC	$257.04	$363.08	$524.81
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $218.78 / $218.78	Facility	26	$218.78	$218.78	$218.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $537.03 / $660.69	Professional		$426.58	$537.03	$660.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $141.25 / $223.87	Professional	26	$125.89	$141.25	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $398.11 / $524.81	Professional	TC	$302.00	$398.11	$524.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $131.83 / $302.00	Professional		$54.95	$131.83	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $316.23 / $602.56	Professional		$213.80	$316.23	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $72.44 / $154.88	Professional	26	$57.54	$72.44	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $446.68	Professional	TC	$162.18	$229.09	$446.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $416.87	Professional		$354.81	$354.81	$416.87
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 $251.19 / $251.19 / $295.12	Professional	TC	$251.19	$251.19	$295.12