Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $60.26 / $323.59	Facility	26	$60.26	$60.26	$323.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $257.04 / $436.52	Professional		$190.55	$257.04	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $64.57 / $134.90	Professional	26	$54.95	$64.57	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $190.55 / $338.84	Professional	TC	$134.90	$190.55	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $194.98 / $204.17	Facility	26	$190.55	$194.98	$204.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $489.78 / $660.69	Professional		$295.12	$489.78	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $138.04 / $173.78	Professional	26	$77.62	$138.04	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $398.11 / $512.86	Professional	TC	$229.09	$398.11	$512.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $1,230.27	Professional		$177.83	$346.74	$1,230.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $100.00 / $331.13	Professional	26	$56.23	$100.00	$331.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $239.88 / $954.99	Professional	TC	$125.89	$239.88	$954.99
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $436.52 / $562.34 / $562.34	Facility	26	$436.52	$562.34	$562.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $436.52 / $2,290.87	Professional		$234.42	$436.52	$2,290.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $524.81	Professional	26	$61.66	$93.33	$524.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $309.03 / $2,398.83	Professional	TC	$165.96	$309.03	$2,398.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $831.76	Professional		$398.11	$562.34	$831.76
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $204.17	Professional	26	$120.23	$138.04	$204.17
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 $204.17 / $204.17 / $204.17	Facility	26	$204.17	$204.17	$204.17
Midlands Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $524.81 / $831.76	Professional		$467.74	$524.81	$831.76
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $138.04 / $208.93	Professional	26	$120.23	$138.04	$208.93
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $398.11 / $724.44	Professional	TC	$331.13	$398.11	$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 $61.66 / $77.62 / $158.49	Professional	26	$61.66	$77.62	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $245.47 / $446.68	Professional	TC	$158.49	$245.47	$446.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $457.09	Professional		$380.19	$380.19	$457.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $134.90	Professional	26	$114.82	$114.82	$134.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $269.15 / $316.23	Professional	TC	$269.15	$269.15	$316.23