Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $123.03 / $165.96	Facility	26	$81.28	$123.03	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $478.63 / $1,548.82	Professional		$190.55	$478.63	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $162.18 / $446.68	Professional	26	$77.62	$162.18	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $338.84 / $794.33	Professional	TC	$245.47	$338.84	$794.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $251.19 / $257.04	Facility	26	$245.47	$251.19	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $776.25 / $1,047.13	Professional		$457.09	$776.25	$1,047.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $177.83 / $223.87	Professional	26	$100.00	$177.83	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $588.84 / $831.76	Professional	TC	$354.81	$588.84	$831.76
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $549.54 / $2,041.74	Professional		$281.84	$549.54	$2,041.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $436.52	Professional	26	$70.79	$128.82	$436.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $407.38 / $1,698.24	Professional	TC	$213.80	$407.38	$1,698.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $724.44 / $724.44	Facility	26	$562.34	$724.44	$724.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $724.44 / $3,311.31	Professional		$407.38	$724.44	$3,311.31
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $120.23 / $602.56	Professional	26	$79.43	$120.23	$602.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $478.63 / $2,951.21	Professional	TC	$288.40	$478.63	$2,951.21
Midlands Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,000.00 / $1,096.48	Professional		$630.96	$1,000.00	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $177.83 / $239.88	Professional	26	$154.88	$177.83	$239.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $776.25 / $912.01	Professional	TC	$478.63	$776.25	$912.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	26	$257.04	$257.04	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $1,096.48	Professional		$741.31	$741.31	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $173.78 / $234.42	Professional	26	$144.54	$173.78	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $575.44 / $912.01	Professional	TC	$562.34	$575.44	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $245.47 / $524.81	Professional		$77.62	$245.47	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $537.03 / $1,096.48	Professional		$371.54	$537.03	$1,096.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $112.20 / $234.42	Professional	26	$79.43	$112.20	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $426.58 / $851.14	Professional	TC	$288.40	$426.58	$851.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $707.95 / $831.76	Professional		$707.95	$707.95	$831.76
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $169.82 / $199.53	Professional	26	$169.82	$169.82	$199.53
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $537.03 / $630.96	Professional	TC	$537.03	$537.03	$630.96