Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $45.71 / $112.20	Facility	26	$44.67	$45.71	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $251.19 / $954.99	Professional		$128.82	$251.19	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $67.61 / $204.17	Professional	26	$42.66	$67.61	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $138.04 / $316.23	Professional	TC	$81.28	$138.04	$316.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $154.88 / $158.49	Facility	26	$147.91	$154.88	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $478.63	Professional		$199.53	$331.13	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $109.65 / $138.04	Professional	26	$63.10	$109.65	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $239.88 / $346.74	Professional	TC	$141.25	$239.88	$346.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $229.09 / $891.25	Professional		$120.23	$229.09	$891.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $85.11 / $257.04	Professional	26	$43.65	$85.11	$257.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $144.54 / $630.96	Professional	TC	$75.86	$144.54	$630.96
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $338.84 / $446.68 / $446.68	Facility	26	$338.84	$446.68	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $302.00 / $1,621.81	Professional		$158.49	$302.00	$1,621.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $380.19	Professional	26	$50.12	$75.86	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $194.98 / $1,318.26	Professional	TC	$107.15	$194.98	$1,318.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $363.08 / $562.34	Professional		$263.03	$363.08	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $117.49 / $158.49	Professional	26	$95.50	$117.49	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $239.88 / $426.58	Professional	TC	$165.96	$239.88	$426.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $316.23 / $562.34	Professional		$309.03	$316.23	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $109.65 / $245.47	Professional	26	$87.10	$109.65	$245.47
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $213.80 / $426.58	Professional	TC	$199.53	$213.80	$426.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $102.33 / $223.87	Professional		$48.98	$102.33	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $223.87 / $389.05	Professional		$151.36	$223.87	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $125.89	Professional	26	$48.98	$63.10	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $154.88 / $281.84	Professional	TC	$102.33	$154.88	$281.84
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 $89.13 / $89.13 / $104.71	Professional	26	$89.13	$89.13	$104.71
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $190.55	Professional	TC	$162.18	$162.18	$190.55