Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $128.82 / $141.25	Facility	26	$64.57	$128.82	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $407.38 / $1,584.89	Professional		$229.09	$407.38	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $93.33 / $251.19	Professional	26	$60.26	$93.33	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $257.04 / $1,023.29	Professional	TC	$162.18	$257.04	$1,023.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $218.78 / $223.87	Facility	26	$213.80	$218.78	$223.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $630.96 / $794.33	Professional		$380.19	$630.96	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $154.88 / $190.55	Professional	26	$85.11	$154.88	$190.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $478.63 / $660.69	Professional	TC	$295.12	$478.63	$660.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $457.09 / $1,258.93	Professional		$234.42	$457.09	$1,258.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $109.65 / $302.00	Professional	26	$61.66	$109.65	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $338.84 / $1,071.52	Professional	TC	$177.83	$338.84	$1,071.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $478.63 / $616.60 / $616.60	Facility	26	$478.63	$616.60	$616.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $512.86 / $2,398.83	Professional		$288.40	$512.86	$2,398.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $102.33 / $537.03	Professional	26	$67.61	$102.33	$537.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $363.08 / $2,630.27	Professional	TC	$199.53	$363.08	$2,630.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $707.95 / $870.96	Professional		$478.63	$707.95	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $162.18 / $204.17	Professional	26	$131.83	$162.18	$204.17
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $724.44	Professional	TC	$346.74	$501.19	$724.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $223.87 / $223.87 / $223.87	Facility	26	$223.87	$223.87	$223.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $588.84 / $870.96	Professional		$512.86	$588.84	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $154.88 / $229.09	Professional	26	$123.03	$154.88	$229.09
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $426.58 / $724.44	Professional	TC	$371.54	$426.58	$724.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $218.78 / $457.09	Professional		$67.61	$218.78	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $389.05 / $660.69	Professional		$269.15	$389.05	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $177.83	Professional	26	$69.18	$87.10	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $288.40 / $489.78	Professional	TC	$199.53	$288.40	$489.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $602.56	Professional		$501.19	$501.19	$602.56
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $125.89 / $147.91	Professional	26	$125.89	$125.89	$147.91
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $380.19 / $446.68	Professional	TC	$380.19	$380.19	$446.68