Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $354.81	Facility	26	$57.54	$57.54	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $1,318.26	Professional		$190.55	$275.42	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $87.10 / $302.00	Professional	26	$54.95	$87.10	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $501.19	Professional	TC	$134.90	$213.80	$501.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $208.93 / $213.80	Facility	26	$204.17	$208.93	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $489.78 / $660.69	Professional		$302.00	$489.78	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $138.04 / $169.82	Professional	26	$79.43	$138.04	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $389.05 / $512.86	Professional	TC	$229.09	$389.05	$512.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $1,288.25	Professional		$177.83	$346.74	$1,288.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $102.33 / $371.54	Professional	26	$54.95	$102.33	$371.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $239.88 / $977.24	Professional	TC	$125.89	$239.88	$977.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $549.54 / $549.54	Facility	26	$426.58	$549.54	$549.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $2,344.23	Professional		$239.88	$436.52	$2,344.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $100.00 / $537.03	Professional	26	$67.61	$100.00	$537.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $302.00 / $1,995.26	Professional	TC	$158.49	$302.00	$1,995.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $851.14	Professional		$398.11	$562.34	$851.14
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $141.25 / $199.53	Professional	26	$117.49	$141.25	$199.53
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $398.11 / $724.44	Professional	TC	$275.42	$398.11	$724.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $537.03 / $851.14	Professional		$467.74	$537.03	$851.14
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $141.25 / $223.87	Professional	26	$120.23	$141.25	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $389.05 / $724.44	Professional	TC	$331.13	$389.05	$724.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $141.25 / $331.13	Professional		$60.26	$141.25	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $331.13 / $588.84	Professional		$223.87	$331.13	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $85.11 / $173.78	Professional	26	$67.61	$85.11	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $229.09 / $446.68	Professional	TC	$158.49	$229.09	$446.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $446.68	Professional		$380.19	$380.19	$446.68
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $131.83	Professional	26	$112.20	$112.20	$131.83
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $269.15 / $316.23	Professional	TC	$269.15	$269.15	$316.23