Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $309.03	Facility	26	$74.13	$74.13	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $1,621.81	Professional		$251.19	$426.58	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $117.49 / $302.00	Professional	26	$70.79	$117.49	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $281.84 / $549.54	Professional	TC	$177.83	$281.84	$549.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $181.97 / $186.21	Facility	26	$177.83	$181.97	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $630.96 / $831.76	Professional		$407.38	$630.96	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $165.96 / $204.17	Professional	26	$74.13	$165.96	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $501.19 / $707.95	Professional	TC	$331.13	$501.19	$707.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $426.58 / $1,698.24	Professional		$223.87	$426.58	$1,698.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $107.15 / $457.09	Professional	26	$66.07	$107.15	$457.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $302.00 / $1,318.26	Professional	TC	$158.49	$302.00	$1,318.26
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $660.69 / $660.69	Facility	26	$512.86	$660.69	$660.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $602.56 / $3,090.30	Professional		$281.84	$602.56	$3,090.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $95.50 / $870.96	Professional	26	$61.66	$95.50	$870.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $416.87 / $2,754.23	Professional	TC	$190.55	$416.87	$2,754.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $776.25 / $1,047.13	Professional		$489.78	$776.25	$1,047.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $165.96 / $218.78	Professional	26	$131.83	$165.96	$218.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $562.34 / $912.01	Professional	TC	$354.81	$562.34	$912.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	26	$186.21	$186.21	$186.21
Midlands Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $630.96 / $1,047.13	Professional		$588.84	$630.96	$1,047.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $165.96 / $213.80	Professional	26	$104.71	$165.96	$213.80
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $501.19 / $912.01	Professional	TC	$426.58	$501.19	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $181.97 / $416.87	Professional		$72.44	$181.97	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $389.05 / $724.44	Professional		$257.04	$389.05	$724.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $87.10 / $186.21	Professional	26	$60.26	$87.10	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $281.84 / $575.44	Professional	TC	$181.97	$281.84	$575.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $660.69	Professional		$562.34	$562.34	$660.69
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $158.49 / $186.21	Professional	26	$158.49	$158.49	$186.21
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $398.11 / $467.74	Professional	TC	$398.11	$398.11	$467.74