Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $309.03	Facility	26	$57.54	$57.54	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $281.84 / $1,348.96	Professional		$218.78	$281.84	$1,348.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $66.07 / $177.83	Professional	26	$54.95	$66.07	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $436.52	Professional	TC	$162.18	$218.78	$436.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $186.21 / $190.55	Facility	26	$181.97	$186.21	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $616.60 / $758.58	Professional		$371.54	$616.60	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $134.90 / $165.96	Professional	26	$74.13	$134.90	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $478.63 / $602.56	Professional	TC	$295.12	$478.63	$602.56
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $436.52 / $1,258.93	Professional		$229.09	$436.52	$1,258.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $295.12	Professional	26	$53.70	$95.50	$295.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $1,023.29	Professional	TC	$177.83	$338.84	$1,023.29
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $416.87 / $537.03 / $537.03	Facility	26	$416.87	$537.03	$537.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $501.19 / $2,187.76	Professional		$281.84	$501.19	$2,187.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $89.13 / $436.52	Professional	26	$60.26	$89.13	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $338.84 / $1,905.46	Professional	TC	$204.17	$338.84	$1,905.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $691.83 / $812.83	Professional		$457.09	$691.83	$812.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $131.83 / $177.83	Professional	26	$114.82	$131.83	$177.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $691.83	Professional	TC	$346.74	$501.19	$691.83
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $562.34 / $812.83	Professional		$501.19	$562.34	$812.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $134.90 / $173.78	Professional	26	$104.71	$134.90	$173.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $426.58 / $691.83	Professional	TC	$380.19	$426.58	$691.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $199.53 / $426.58	Professional		$58.88	$199.53	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $660.69	Professional		$263.03	$371.54	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $74.13 / $151.36	Professional	26	$60.26	$74.13	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $288.40 / $501.19	Professional	TC	$204.17	$288.40	$501.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $575.44	Professional		$489.78	$489.78	$575.44
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $109.65 / $128.82	Professional	26	$109.65	$109.65	$128.82
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $380.19 / $446.68	Professional	TC	$380.19	$380.19	$446.68