Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $87.10 / $117.49	Facility	26	$51.29	$87.10	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $245.47 / $512.86	Professional		$117.49	$245.47	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $208.93	Professional	26	$52.48	$81.28	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $416.87	Professional	TC	$144.54	$204.17	$416.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $181.97 / $186.21	Facility	26	$173.78	$181.97	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $489.78 / $616.60	Professional		$295.12	$489.78	$616.60
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 $218.78 / $363.08 / $478.63	Professional	TC	$218.78	$363.08	$478.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $338.84 / $977.24	Professional		$181.97	$338.84	$977.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $245.47	Professional	26	$51.29	$91.20	$245.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $257.04 / $776.25	Professional	TC	$131.83	$257.04	$776.25
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 $229.09 / $416.87 / $1,621.81	Professional		$229.09	$416.87	$1,621.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $346.74	Professional	26	$56.23	$85.11	$346.74
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $263.03 / $1,318.26	Professional	TC	$158.49	$263.03	$1,318.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $645.65	Professional		$398.11	$562.34	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $125.89 / $169.82	Professional	26	$109.65	$125.89	$169.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $416.87 / $501.19	Professional	TC	$295.12	$416.87	$501.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	26	$186.21	$186.21	$186.21
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $478.63 / $616.60	Professional		$436.52	$478.63	$616.60
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $128.82 / $190.55	Professional	26	$102.33	$128.82	$190.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $346.74 / $501.19	Professional	TC	$316.23	$346.74	$501.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $151.36 / $338.84	Professional		$56.23	$151.36	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $288.40 / $537.03	Professional		$213.80	$288.40	$537.03
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 $158.49 / $223.87 / $389.05	Professional	TC	$158.49	$223.87	$389.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $457.09	Professional		$389.05	$389.05	$457.09
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 $288.40 / $288.40 / $338.84	Professional	TC	$288.40	$288.40	$338.84