Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $109.65 / $120.23	Facility	26	$56.23	$109.65	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $263.03 / $933.25	Professional		$138.04	$263.03	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $87.10 / $263.03	Professional	26	$53.70	$87.10	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $338.84	Professional	TC	$81.28	$128.82	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $181.97 / $190.55	Facility	26	$177.83	$181.97	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $489.78	Professional		$199.53	$331.13	$489.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $131.83 / $162.18	Professional	26	$74.13	$131.83	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $204.17 / $346.74	Professional	TC	$134.90	$204.17	$346.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $239.88 / $851.14	Professional		$125.89	$239.88	$851.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $93.33 / $269.15	Professional	26	$52.48	$93.33	$269.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $141.25 / $575.44	Professional	TC	$74.13	$141.25	$575.44
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $407.38 / $524.81 / $524.81	Facility	26	$407.38	$524.81	$524.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $295.12 / $1,548.82	Professional		$154.88	$295.12	$1,548.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $389.05	Professional	26	$58.88	$87.10	$389.05
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $181.97 / $1,659.59	Professional	TC	$87.10	$181.97	$1,659.59
Midlands Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $562.34	Professional		$275.42	$389.05	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $134.90 / $181.97	Professional	26	$112.20	$134.90	$181.97
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $234.42 / $426.58	Professional	TC	$162.18	$234.42	$426.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $323.59 / $562.34	Professional		$295.12	$323.59	$562.34
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $194.98	Professional	26	$104.71	$131.83	$194.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $194.98 / $426.58	Professional	TC	$169.82	$194.98	$426.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $120.23 / $234.42	Professional		$57.54	$120.23	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $363.08	Professional		$147.91	$213.80	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $72.44 / $147.91	Professional	26	$58.88	$72.44	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $125.89 / $229.09	Professional	TC	$85.11	$125.89	$229.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $316.23	Professional		$269.15	$269.15	$316.23
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $107.15 / $125.89	Professional	26	$107.15	$107.15	$125.89
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $186.21	Professional	TC	$158.49	$158.49	$186.21