Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $95.50 / $177.83	Facility	26	$79.43	$95.50	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $1,862.09	Professional		$275.42	$426.58	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $97.72 / $363.08	Professional	26	$79.43	$97.72	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $302.00 / $1,258.93	Professional	TC	$213.80	$302.00	$1,258.93
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 $416.87 / $741.31 / $912.01	Professional		$416.87	$741.31	$912.01
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 $309.03 / $537.03 / $676.08	Professional	TC	$309.03	$537.03	$676.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $416.87 / $1,479.11	Professional		$269.15	$416.87	$1,479.11
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $131.83 / $436.52	Professional	26	$81.28	$131.83	$436.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $288.40 / $1,096.48	Professional	TC	$194.98	$288.40	$1,096.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $812.83 / $812.83	Facility	26	$630.96	$812.83	$812.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $588.84 / $2,089.30	Professional		$323.59	$588.84	$2,089.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $154.88 / $549.54	Professional	26	$89.13	$154.88	$549.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $309.03 / $2,630.27	Professional	TC	$218.78	$309.03	$2,630.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $776.25 / $870.96	Professional		$602.56	$776.25	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $213.80 / $234.42	Professional	26	$173.78	$213.80	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $575.44 / $630.96	Professional	TC	$436.52	$575.44	$630.96
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 $602.56 / $691.83 / $870.96	Professional		$602.56	$691.83	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $186.21 / $234.42	Professional	26	$173.78	$186.21	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $512.86 / $630.96	Professional	TC	$416.87	$512.86	$630.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $223.87 / $512.86	Professional		$87.10	$223.87	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $398.11 / $794.33	Professional		$316.23	$398.11	$794.33
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 $229.09 / $281.84 / $549.54	Professional	TC	$229.09	$281.84	$549.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $588.84 / $691.83	Professional		$588.84	$588.84	$691.83
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 $426.58 / $426.58 / $501.19	Professional	TC	$426.58	$426.58	$501.19