Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $107.15 / $117.49	Facility	26	$51.29	$107.15	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $309.03 / $1,318.26	Professional		$223.87	$309.03	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $100.00 / $213.80	Professional	26	$52.48	$100.00	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $446.68	Professional	TC	$162.18	$218.78	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $177.83 / $181.97	Facility	26	$173.78	$177.83	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $549.54 / $691.83	Professional		$331.13	$549.54	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $158.49	Professional	26	$70.79	$128.82	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $426.58 / $537.03	Professional	TC	$257.04	$426.58	$537.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $380.19 / $1,000.00	Professional		$204.17	$380.19	$1,000.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $251.19	Professional	26	$51.29	$91.20	$251.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $302.00 / $812.83	Professional	TC	$158.49	$302.00	$812.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $398.11 / $512.86 / $512.86	Facility	26	$398.11	$512.86	$512.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $446.68 / $1,819.70	Professional		$251.19	$446.68	$1,819.70
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $363.08	Professional	26	$56.23	$85.11	$363.08
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $275.42 / $1,513.56	Professional	TC	$177.83	$275.42	$1,513.56
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $575.44 / $676.08	Professional		$457.09	$575.44	$676.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $177.83	Professional	26	$109.65	$125.89	$177.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $457.09 / $549.54	Professional	TC	$346.74	$457.09	$549.54
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $181.97 / $181.97	Facility	26	$181.97	$181.97	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $537.03 / $660.69	Professional		$436.52	$537.03	$660.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $190.55	Professional	26	$109.65	$128.82	$190.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $416.87 / $549.54	Professional	TC	$323.59	$416.87	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $177.83 / $380.19	Professional		$56.23	$177.83	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $295.12 / $575.44	Professional		$234.42	$295.12	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $144.54	Professional	26	$56.23	$70.79	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $234.42 / $426.58	Professional	TC	$177.83	$234.42	$426.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $446.68 / $524.81	Professional		$446.68	$446.68	$524.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $123.03	Professional	26	$104.71	$104.71	$123.03
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $398.11	Professional	TC	$338.84	$338.84	$398.11