Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $85.11 / $181.97	Facility	26	$79.43	$85.11	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $331.13 / $1,659.59	Professional		$245.47	$331.13	$1,659.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $120.23 / $338.84	Professional	26	$77.62	$120.23	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $218.78 / $562.34	Professional	TC	$162.18	$218.78	$562.34
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $288.40 / $295.12 / $302.00	Facility	26	$288.40	$295.12	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $741.31 / $933.25	Professional		$446.68	$741.31	$933.25
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 $338.84 / $549.54 / $707.95	Professional	TC	$338.84	$549.54	$707.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $537.03 / $1,445.44	Professional		$275.42	$537.03	$1,445.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $147.91 / $398.11	Professional	26	$79.43	$147.91	$398.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $380.19 / $1,122.02	Professional	TC	$199.53	$380.19	$1,122.02
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $794.33 / $794.33	Facility	26	$630.96	$794.33	$794.33
Medica Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $588.84 / $3,090.30	Professional		$331.13	$588.84	$3,090.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $660.69	Professional	26	$89.13	$131.83	$660.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $407.38 / $2,630.27	Professional	TC	$223.87	$407.38	$2,630.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $776.25 / $954.99	Professional		$512.86	$776.25	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $208.93 / $269.15	Professional	26	$169.82	$208.93	$269.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $758.58	Professional	TC	$346.74	$501.19	$758.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $302.00 / $302.00	Facility	26	$302.00	$302.00	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $630.96 / $954.99	Professional		$602.56	$630.96	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $186.21 / $234.42	Professional	26	$165.96	$186.21	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $426.58 / $758.58	Professional	TC	$416.87	$426.58	$758.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $245.47 / $512.86	Professional		$89.13	$245.47	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $457.09 / $776.25	Professional		$309.03	$457.09	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $112.20 / $229.09	Professional	26	$89.13	$112.20	$229.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $331.13 / $549.54	Professional	TC	$223.87	$331.13	$549.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $602.56 / $707.95	Professional		$602.56	$602.56	$707.95
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $194.98	Professional	26	$165.96	$165.96	$194.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $436.52 / $512.86	Professional	TC	$436.52	$436.52	$512.86