Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $194.98 / $223.87	Facility	26	$100.00	$194.98	$223.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $537.03 / $3,019.95	Professional		$331.13	$537.03	$3,019.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $223.87 / $602.56	Professional	26	$104.71	$223.87	$602.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $1,047.13	Professional	TC	$218.78	$338.84	$1,047.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $389.05 / $407.38	Facility	26	$380.19	$389.05	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $870.96 / $1,258.93	Professional		$512.86	$870.96	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $251.19 / $331.13	Professional	26	$144.54	$251.19	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $602.56 / $1,096.48	Professional	TC	$354.81	$602.56	$1,096.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $562.34 / $2,818.38	Professional		$295.12	$562.34	$2,818.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $190.55 / $588.84	Professional	26	$102.33	$190.55	$588.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $371.54 / $2,187.76	Professional	TC	$194.98	$371.54	$2,187.76
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $794.33 / $1,023.29 / $1,023.29	Facility	26	$794.33	$1,023.29	$1,023.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $831.76 / $6,165.95	Professional		$407.38	$831.76	$6,165.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $169.82 / $933.25	Professional	26	$117.49	$169.82	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $602.56 / $5,495.41	Professional	TC	$257.04	$602.56	$5,495.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,023.29 / $1,479.11	Professional		$645.65	$1,023.29	$1,479.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $288.40 / $363.08	Professional	26	$218.78	$288.40	$363.08
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $691.83 / $1,202.26	Professional	TC	$426.58	$691.83	$1,202.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $407.38 / $407.38 / $407.38	Facility	26	$407.38	$407.38	$407.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $758.58 / $1,479.11	Professional		$741.31	$758.58	$1,479.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $257.04 / $389.05	Professional	26	$223.87	$257.04	$389.05
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $512.86 / $1,202.26	Professional	TC	$512.86	$512.86	$1,202.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $234.42 / $537.03	Professional		$109.65	$234.42	$537.03
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $588.84 / $1,096.48	Professional		$371.54	$588.84	$1,096.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $158.49 / $338.84	Professional	26	$117.49	$158.49	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $398.11 / $870.96	Professional	TC	$257.04	$398.11	$870.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $724.44 / $851.14	Professional		$724.44	$724.44	$851.14
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $281.84	Professional	26	$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $489.78 / $575.44	Professional	TC	$489.78	$489.78	$575.44