Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $89.13 / $144.54	Facility	26	$79.43	$89.13	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $457.09 / $1,318.26	Professional		$338.84	$457.09	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $125.89 / $501.19	Professional	26	$85.11	$125.89	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $338.84 / $645.65	Professional	TC	$257.04	$338.84	$645.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $275.42 / $281.84	Facility	26	$269.15	$275.42	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $831.76 / $1,096.48	Professional		$478.63	$831.76	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $199.53 / $251.19	Professional	26	$112.20	$199.53	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $630.96 / $851.14	Professional	TC	$371.54	$630.96	$851.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $588.84 / $1,819.70	Professional		$309.03	$588.84	$1,819.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $141.25 / $407.38	Professional	26	$79.43	$141.25	$407.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $436.52 / $1,479.11	Professional	TC	$229.09	$436.52	$1,479.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $616.60 / $794.33 / $794.33	Facility	26	$616.60	$794.33	$794.33
Medica Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $724.44 / $3,019.95	Professional		$389.05	$724.44	$3,019.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $123.03 / $851.14	Professional	26	$87.10	$123.03	$851.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $467.74 / $2,570.40	Professional	TC	$275.42	$467.74	$2,570.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,023.29 / $1,096.48	Professional		$676.08	$1,023.29	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $199.53 / $263.03	Professional	26	$169.82	$199.53	$263.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $812.83 / $912.01	Professional	TC	$501.19	$812.83	$912.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $281.84 / $281.84 / $281.84	Facility	26	$281.84	$281.84	$281.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $794.33 / $1,096.48	Professional		$776.25	$794.33	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $199.53 / $257.04	Professional	26	$158.49	$199.53	$257.04
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $602.56 / $912.01	Professional	TC	$588.84	$602.56	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $263.03 / $562.34	Professional		$87.10	$263.03	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $489.78 / $977.24	Professional		$363.08	$489.78	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $104.71 / $234.42	Professional	26	$87.10	$104.71	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $398.11 / $741.31	Professional	TC	$269.15	$398.11	$741.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $758.58 / $891.25	Professional		$758.58	$758.58	$891.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $190.55 / $223.87	Professional	26	$190.55	$190.55	$223.87
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $676.08	Professional	TC	$575.44	$575.44	$676.08