Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $141.25 / $177.83	Facility	26	$79.43	$141.25	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $436.52 / $1,905.46	Professional		$245.47	$436.52	$1,905.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $93.33 / $338.84	Professional	26	$77.62	$93.33	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $676.08	Professional	TC	$162.18	$234.42	$676.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $281.84 / $295.12 / $302.00	Facility	26	$281.84	$295.12	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $691.83 / $870.96	Professional		$416.87	$691.83	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $199.53 / $251.19	Professional	26	$112.20	$199.53	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $489.78 / $676.08	Professional	TC	$302.00	$489.78	$676.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $489.78 / $1,479.11	Professional		$257.04	$489.78	$1,479.11
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $147.91 / $398.11	Professional	26	$79.43	$147.91	$398.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $1,148.15	Professional	TC	$177.83	$338.84	$1,148.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $812.83 / $812.83	Facility	26	$630.96	$812.83	$812.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $575.44 / $3,162.28	Professional		$309.03	$575.44	$3,162.28
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $154.88 / $1,000.00	Professional	26	$93.33	$154.88	$1,000.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $380.19 / $2,691.53	Professional	TC	$204.17	$380.19	$2,691.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $776.25 / $954.99	Professional		$512.86	$776.25	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $269.15	Professional	26	$173.78	$213.80	$269.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $758.58	Professional	TC	$346.74	$501.19	$758.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $302.00 / $302.00	Facility	26	$302.00	$302.00	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $630.96 / $954.99	Professional		$588.84	$630.96	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $186.21 / $234.42	Professional	26	$165.96	$186.21	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $398.11 / $426.58 / $758.58	Professional	TC	$398.11	$426.58	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $204.17 / $478.63	Professional		$87.10	$204.17	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $426.58 / $758.58	Professional		$295.12	$426.58	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $229.09	Professional	26	$89.13	$112.20	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $302.00 / $524.81	Professional	TC	$204.17	$302.00	$524.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $645.65	Professional		$549.54	$549.54	$645.65
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $194.98	Professional	26	$165.96	$165.96	$194.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $389.05 / $457.09	Professional	TC	$389.05	$389.05	$457.09