Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $173.78	Facility	26	$89.13	$89.13	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $1,778.28	Professional		$275.42	$426.58	$1,778.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $134.90 / $467.74	Professional	26	$83.18	$134.90	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $588.84	Professional	TC	$190.55	$302.00	$588.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $275.42 / $281.84	Facility	26	$263.03	$275.42	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $707.95 / $954.99	Professional		$446.68	$707.95	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $194.98 / $257.04	Professional	26	$109.65	$194.98	$257.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $501.19 / $776.25	Professional	TC	$316.23	$501.19	$776.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $478.63 / $1,995.26	Professional		$245.47	$478.63	$1,995.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $141.25 / $537.03	Professional	26	$79.43	$141.25	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $323.59 / $1,548.82	Professional	TC	$169.82	$323.59	$1,548.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $616.60 / $794.33 / $794.33	Facility	26	$616.60	$794.33	$794.33
Medica Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $630.96 / $3,467.37	Professional		$346.74	$630.96	$3,467.37
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $131.83 / $660.69	Professional	26	$87.10	$131.83	$660.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $478.63 / $3,019.95	Professional	TC	$223.87	$478.63	$3,019.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $870.96 / $1,096.48	Professional		$549.54	$870.96	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $208.93 / $288.40	Professional	26	$169.82	$208.93	$288.40
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $602.56 / $912.01	Professional	TC	$371.54	$602.56	$912.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $281.84 / $281.84 / $281.84	Facility	26	$281.84	$281.84	$281.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $645.65 / $1,096.48	Professional		$630.96	$645.65	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $199.53 / $269.15	Professional	26	$154.88	$199.53	$269.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $446.68 / $912.01	Professional	TC	$446.68	$446.68	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $194.98 / $457.09	Professional		$85.11	$194.98	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $501.19 / $912.01	Professional		$316.23	$501.19	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $123.03 / $257.04	Professional	26	$87.10	$123.03	$257.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $660.69	Professional	TC	$223.87	$354.81	$660.69
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $616.60 / $724.44	Professional		$616.60	$616.60	$724.44
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $186.21 / $223.87	Professional	26	$186.21	$186.21	$223.87
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $426.58 / $501.19	Professional	TC	$426.58	$426.58	$501.19