Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $213.80 / $218.78	Facility	26	$107.15	$213.80	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $537.03 / $2,570.40	Professional		$257.04	$537.03	$2,570.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $186.21 / $524.81	Professional	26	$100.00	$186.21	$524.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $407.38 / $1,288.25	Professional	TC	$281.84	$407.38	$1,288.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $316.23 / $331.13 / $338.84	Facility	26	$316.23	$331.13	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $954.99 / $1,318.26	Professional		$549.54	$954.99	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $239.88 / $295.12	Professional	26	$131.83	$239.88	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $724.44 / $1,096.48	Professional	TC	$426.58	$724.44	$1,096.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $676.08 / $2,754.23	Professional		$346.74	$676.08	$2,754.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $169.82 / $562.34	Professional	26	$95.50	$169.82	$562.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $489.78 / $2,290.87	Professional	TC	$257.04	$489.78	$2,290.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $741.31 / $954.99 / $954.99	Facility	26	$741.31	$954.99	$954.99
Medica Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $954.99 / $6,025.60	Professional		$501.19	$954.99	$6,025.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $173.78 / $891.25	Professional	26	$104.71	$173.78	$891.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $630.96 / $5,495.41	Professional	TC	$346.74	$630.96	$5,495.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,230.27 / $1,445.44	Professional		$776.25	$1,230.27	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $245.47 / $346.74	Professional	26	$204.17	$245.47	$346.74
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $933.25 / $1,202.26	Professional	TC	$575.44	$933.25	$1,202.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $338.84 / $338.84 / $338.84	Facility	26	$338.84	$338.84	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $1,445.44	Professional		$912.01	$912.01	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $229.09 / $309.03	Professional	26	$186.21	$229.09	$309.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $691.83 / $1,202.26	Professional	TC	$676.08	$691.83	$1,202.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $295.12 / $645.65	Professional		$104.71	$295.12	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $707.95 / $1,348.96	Professional		$457.09	$707.95	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $147.91 / $309.03	Professional	26	$104.71	$147.91	$309.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $537.03 / $1,023.29	Professional	TC	$346.74	$537.03	$1,023.29
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $1,023.29	Professional		$870.96	$870.96	$1,023.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $229.09 / $269.15	Professional	26	$229.09	$229.09	$269.15
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $645.65 / $758.58	Professional	TC	$645.65	$645.65	$758.58