Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $177.83 / $234.42	Facility	26	$100.00	$177.83	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $549.54 / $2,691.53	Professional		$331.13	$549.54	$2,691.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $194.98 / $562.34	Professional	26	$102.33	$194.98	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $1,148.15	Professional	TC	$218.78	$338.84	$1,148.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $363.08 / $371.54	Facility	26	$354.81	$363.08	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $891.25 / $1,258.93	Professional		$524.81	$891.25	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $251.19 / $331.13	Professional	26	$141.25	$251.19	$331.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $588.84 / $1,122.02	Professional	TC	$354.81	$588.84	$1,122.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $562.34 / $2,818.38	Professional		$288.40	$562.34	$2,818.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $181.97 / $537.03	Professional	26	$102.33	$181.97	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $371.54 / $2,290.87	Professional	TC	$190.55	$371.54	$2,290.87
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 $114.82 / $169.82 / $912.01	Professional	26	$114.82	$169.82	$912.01
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $616.60 / $5,495.41	Professional	TC	$257.04	$616.60	$5,495.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,023.29 / $1,445.44	Professional		$645.65	$1,023.29	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $263.03 / $371.54	Professional	26	$218.78	$263.03	$371.54
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 $371.54 / $371.54 / $371.54	Facility	26	$371.54	$371.54	$371.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $758.58 / $1,445.44	Professional		$741.31	$758.58	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $257.04 / $354.81	Professional	26	$204.17	$257.04	$354.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $501.19 / $1,202.26	Professional	TC	$501.19	$501.19	$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 $114.82 / $158.49 / $338.84	Professional	26	$114.82	$158.49	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $398.11 / $891.25	Professional	TC	$251.19	$398.11	$891.25
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 $478.63 / $478.63 / $562.34	Professional	TC	$478.63	$478.63	$562.34