Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $74.13 / $151.36	Facility	26	$64.57	$74.13	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $457.09 / $1,698.24	Professional		$199.53	$457.09	$1,698.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $128.82 / $407.38	Professional	26	$64.57	$128.82	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $275.42 / $741.31	Professional	TC	$123.03	$275.42	$741.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $245.47 / $251.19	Facility	26	$239.88	$245.47	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $524.81 / $870.96	Professional		$316.23	$524.81	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $162.18 / $213.80	Professional	26	$91.20	$162.18	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $338.84 / $707.95	Professional	TC	$204.17	$338.84	$707.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $338.84 / $1,737.80	Professional		$173.78	$338.84	$1,737.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $117.49 / $363.08	Professional	26	$64.57	$117.49	$363.08
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $213.80 / $1,380.38	Professional	TC	$109.65	$213.80	$1,380.38
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 $239.88 / $501.19 / $3,162.28	Professional		$239.88	$501.19	$3,162.28
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $120.23 / $602.56	Professional	26	$75.86	$120.23	$602.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $346.74 / $2,754.23	Professional	TC	$144.54	$346.74	$2,754.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $602.56 / $954.99	Professional		$380.19	$602.56	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $181.97 / $239.88	Professional	26	$141.25	$181.97	$239.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $389.05 / $776.25	Professional	TC	$245.47	$389.05	$776.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $457.09 / $954.99	Professional		$436.52	$457.09	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $162.18 / $239.88	Professional	26	$138.04	$162.18	$239.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $776.25	Professional	TC	$288.40	$288.40	$776.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $147.91 / $323.59	Professional		$70.79	$147.91	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $354.81 / $676.08	Professional		$218.78	$354.81	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $102.33 / $223.87	Professional	26	$75.86	$102.33	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $229.09 / $467.74	Professional	TC	$141.25	$229.09	$467.74
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $436.52 / $512.86	Professional		$436.52	$436.52	$512.86
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $154.88 / $181.97	Professional	26	$154.88	$154.88	$181.97
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $275.42 / $323.59	Professional	TC	$275.42	$275.42	$323.59