Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $141.25 / $165.96	Facility	26	$70.79	$141.25	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $1,548.82	Professional		$218.78	$331.13	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $269.15	Professional	26	$64.57	$107.15	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $524.81	Professional	TC	$144.54	$213.80	$524.81
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 $323.59 / $549.54 / $724.44	Professional		$323.59	$549.54	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $177.83 / $218.78	Professional	26	$89.13	$177.83	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $371.54 / $501.19	Professional	TC	$239.88	$371.54	$501.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $1,202.26	Professional		$199.53	$389.05	$1,202.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $380.19	Professional	26	$70.79	$117.49	$380.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $257.04 / $891.25	Professional	TC	$131.83	$257.04	$891.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $707.95 / $707.95	Facility	26	$549.54	$707.95	$707.95
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $457.09 / $2,041.74	Professional		$251.19	$457.09	$2,041.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $117.49 / $489.78	Professional	26	$74.13	$117.49	$489.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $288.40 / $1,995.26	Professional	TC	$158.49	$288.40	$1,995.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $630.96 / $741.31	Professional		$446.68	$630.96	$741.31
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $186.21 / $257.04	Professional	26	$141.25	$186.21	$257.04
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $416.87 / $602.56	Professional	TC	$288.40	$416.87	$602.56
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 $524.81 / $537.03 / $741.31	Professional		$524.81	$537.03	$741.31
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $177.83 / $234.42	Professional	26	$125.89	$177.83	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $389.05 / $602.56	Professional	TC	$346.74	$389.05	$602.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $162.18 / $371.54	Professional		$75.86	$162.18	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $338.84 / $602.56	Professional		$239.88	$338.84	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $97.72 / $204.17	Professional	26	$74.13	$97.72	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $229.09 / $436.52	Professional	TC	$158.49	$229.09	$436.52
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $426.58 / $512.86	Professional		$426.58	$426.58	$512.86
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $144.54 / $169.82	Professional	26	$144.54	$144.54	$169.82
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $338.84	Professional	TC	$288.40	$288.40	$338.84