Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $123.03 / $141.25	Facility	26	$58.88	$123.03	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $275.42 / $1,380.38	Professional		$204.17	$275.42	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $223.87	Professional	26	$54.95	$72.44	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $208.93 / $389.05	Professional	TC	$147.91	$208.93	$389.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $218.78 / $229.09	Facility	26	$213.80	$218.78	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $524.81 / $707.95	Professional		$331.13	$524.81	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $138.04 / $177.83	Professional	26	$79.43	$138.04	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $426.58 / $537.03	Professional	TC	$251.19	$426.58	$537.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $371.54 / $1,230.27	Professional		$190.55	$371.54	$1,230.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $107.15 / $309.03	Professional	26	$56.23	$107.15	$309.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $263.03 / $977.24	Professional	TC	$138.04	$263.03	$977.24
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 $257.04 / $457.09 / $2,238.72	Professional		$257.04	$457.09	$2,238.72
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $102.33 / $588.84	Professional	26	$63.10	$102.33	$588.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $323.59 / $1,819.70	Professional	TC	$186.21	$323.59	$1,819.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $602.56 / $776.25	Professional		$426.58	$602.56	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $162.18 / $186.21	Professional	26	$120.23	$162.18	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $436.52 / $630.96	Professional	TC	$302.00	$436.52	$630.96
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $588.84 / $776.25	Professional		$501.19	$588.84	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $147.91 / $234.42	Professional	26	$138.04	$147.91	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $436.52 / $630.96	Professional	TC	$363.08	$436.52	$630.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $154.88 / $354.81	Professional		$60.26	$154.88	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $660.69	Professional		$239.88	$346.74	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $79.43 / $162.18	Professional	26	$63.10	$79.43	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $257.04 / $501.19	Professional	TC	$177.83	$257.04	$501.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $478.63	Professional		$407.38	$407.38	$478.63
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 $295.12 / $295.12 / $346.74	Professional	TC	$295.12	$295.12	$346.74