Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $169.82 / $218.78	Facility	26	$97.72	$169.82	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $562.34 / $3,311.31	Professional		$346.74	$562.34	$3,311.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $158.49 / $549.54	Professional	26	$95.50	$158.49	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $346.74 / $1,584.89	Professional	TC	$239.88	$346.74	$1,584.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $331.13 / $346.74 / $354.81	Facility	26	$331.13	$346.74	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $954.99 / $1,258.93	Professional		$549.54	$954.99	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $239.88 / $316.23	Professional	26	$134.90	$239.88	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $724.44 / $1,096.48	Professional	TC	$389.05	$724.44	$1,096.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $588.84 / $2,884.03	Professional		$309.03	$588.84	$2,884.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $177.83 / $426.58	Professional	26	$97.72	$177.83	$426.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $407.38 / $2,511.89	Professional	TC	$213.80	$407.38	$2,511.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $758.58 / $977.24 / $977.24	Facility	26	$758.58	$977.24	$977.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $977.24 / $6,025.60	Professional		$436.52	$977.24	$6,025.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $177.83 / $891.25	Professional	26	$109.65	$177.83	$891.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $660.69 / $5,495.41	Professional	TC	$288.40	$660.69	$5,495.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,071.52 / $1,445.44	Professional		$676.08	$1,071.52	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $257.04 / $354.81	Professional	26	$208.93	$257.04	$354.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $758.58 / $1,202.26	Professional	TC	$467.74	$758.58	$1,202.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $977.24 / $1,445.44	Professional		$812.83	$977.24	$1,445.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $239.88 / $316.23	Professional	26	$194.98	$239.88	$316.23
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $758.58 / $1,202.26	Professional	TC	$562.34	$758.58	$1,202.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $239.88 / $575.44	Professional		$107.15	$239.88	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $630.96 / $1,202.26	Professional		$389.05	$630.96	$1,202.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $151.36 / $331.13	Professional	26	$109.65	$151.36	$331.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $457.09 / $891.25	Professional	TC	$281.84	$457.09	$891.25
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 $229.09 / $229.09 / $275.42	Professional	26	$229.09	$229.09	$275.42
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $537.03 / $630.96	Professional	TC	$537.03	$537.03	$630.96