Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $53.70 / $117.49	Facility	26	$51.29	$53.70	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $204.17 / $524.81	Professional		$112.20	$204.17	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $107.15 / $288.40	Professional	26	$52.48	$107.15	$288.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $173.78 / $426.58	Professional	TC	$112.20	$173.78	$426.58
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 $245.47 / $407.38 / $549.54	Professional		$245.47	$407.38	$549.54
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 $190.55 / $302.00 / $398.11	Professional	TC	$190.55	$302.00	$398.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $295.12 / $851.14	Professional		$151.36	$295.12	$851.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $91.20 / $257.04	Professional	26	$51.29	$91.20	$257.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $194.98 / $645.65	Professional	TC	$102.33	$194.98	$645.65
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 $199.53 / $363.08 / $1,621.81	Professional		$199.53	$363.08	$1,621.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $380.19	Professional	26	$56.23	$85.11	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $239.88 / $1,348.96	Professional	TC	$138.04	$239.88	$1,348.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $467.74 / $616.60	Professional		$331.13	$467.74	$616.60
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 $223.87 / $323.59 / $501.19	Professional	TC	$223.87	$323.59	$501.19
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 $398.11 / $436.52 / $616.60	Professional		$398.11	$436.52	$616.60
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $128.82 / $190.55	Professional	26	$100.00	$128.82	$190.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $323.59 / $501.19	Professional	TC	$269.15	$323.59	$501.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $120.23 / $281.84	Professional		$56.23	$120.23	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $489.78	Professional		$190.55	$275.42	$489.78
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 $131.83 / $190.55 / $354.81	Professional	TC	$131.83	$190.55	$354.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $323.59 / $380.19	Professional		$323.59	$323.59	$380.19
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 $218.78 / $218.78 / $257.04	Professional	TC	$218.78	$218.78	$257.04