Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $61.66 / $109.65	Facility	26	$38.02	$61.66	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $288.40 / $1,000.00	Professional		$128.82	$288.40	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $69.18 / $234.42	Professional	26	$38.02	$69.18	$234.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $190.55 / $645.65	Professional	TC	$87.10	$190.55	$645.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $173.78 / $177.83	Facility	26	$169.82	$173.78	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $446.68	Professional		$208.93	$316.23	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $117.49	Professional	26	$52.48	$95.50	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $223.87 / $346.74	Professional	TC	$147.91	$223.87	$346.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $223.87 / $812.83	Professional		$117.49	$223.87	$812.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $74.13 / $257.04	Professional	26	$38.02	$74.13	$257.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $154.88 / $549.54	Professional	TC	$79.43	$154.88	$549.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $380.19 / $380.19	Facility	26	$295.12	$380.19	$380.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $275.42 / $1,412.54	Professional		$144.54	$275.42	$1,412.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $70.79 / $331.13	Professional	26	$43.65	$70.79	$331.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $1,230.27	Professional	TC	$93.33	$177.83	$1,230.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $363.08 / $512.86	Professional		$257.04	$363.08	$512.86
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $107.15 / $138.04	Professional	26	$81.28	$107.15	$138.04
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $251.19 / $407.38	Professional	TC	$177.83	$251.19	$407.38
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 $269.15 / $302.00 / $512.86	Professional		$269.15	$302.00	$512.86
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $95.50 / $109.65	Professional	26	$38.90	$95.50	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $208.93 / $407.38	Professional	TC	$181.97	$208.93	$407.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $91.20 / $218.78	Professional		$41.69	$91.20	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $354.81	Professional		$134.90	$199.53	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $57.54 / $114.82	Professional	26	$42.66	$57.54	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $134.90 / $239.88	Professional	TC	$93.33	$134.90	$239.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $295.12	Professional		$251.19	$251.19	$295.12
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $77.62 / $91.20	Professional	26	$77.62	$77.62	$91.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $204.17	Professional	TC	$173.78	$173.78	$204.17