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 $169.82 / $257.04 / $524.81	Professional		$169.82	$257.04	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $63.10 / $199.53	Professional	26	$52.48	$63.10	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $190.55 / $354.81	Professional	TC	$134.90	$190.55	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $186.21 / $194.98	Facility	26	$181.97	$186.21	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $489.78 / $660.69	Professional		$309.03	$489.78	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $131.83 / $165.96	Professional	26	$74.13	$131.83	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $389.05 / $489.78	Professional	TC	$234.42	$389.05	$489.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $338.84 / $1,318.26	Professional		$177.83	$338.84	$1,318.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $331.13	Professional	26	$53.70	$95.50	$331.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $239.88 / $1,047.13	Professional	TC	$125.89	$239.88	$1,047.13
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 $239.88 / $436.52 / $2,089.30	Professional		$239.88	$436.52	$2,089.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $89.13 / $380.19	Professional	26	$58.88	$89.13	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $309.03 / $1,737.80	Professional	TC	$173.78	$309.03	$1,737.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $549.54 / $758.58	Professional		$389.05	$549.54	$758.58
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 $275.42 / $398.11 / $645.65	Professional	TC	$275.42	$398.11	$645.65
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Facility	26	$194.98	$194.98	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $537.03 / $758.58	Professional		$467.74	$537.03	$758.58
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $131.83 / $194.98	Professional	26	$107.15	$131.83	$194.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $407.38 / $645.65	Professional	TC	$331.13	$407.38	$645.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $144.54 / $331.13	Professional		$58.88	$144.54	$331.13
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $331.13 / $602.56	Professional		$223.87	$331.13	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.13 / $151.36	Professional	26	$58.88	$74.13	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $245.47 / $467.74	Professional	TC	$165.96	$245.47	$467.74
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $446.68	Professional		$380.19	$380.19	$446.68
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 $269.15 / $269.15 / $323.59	Professional	TC	$269.15	$269.15	$323.59