Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $128.82 / $263.03	Facility	26	$114.82	$128.82	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $512.86 / $2,691.53	Professional		$371.54	$512.86	$2,691.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $245.47 / $660.69	Professional	26	$117.49	$245.47	$660.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $338.84 / $812.83	Professional	TC	$251.19	$338.84	$812.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $398.11 / $407.38	Facility	26	$389.05	$398.11	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $891.25 / $1,202.26	Professional		$524.81	$891.25	$1,202.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $281.84 / $354.81	Professional	26	$158.49	$281.84	$354.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $616.60 / $851.14	Professional	TC	$363.08	$616.60	$851.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $549.54 / $2,754.23	Professional		$323.59	$549.54	$2,754.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $204.17 / $794.33	Professional	26	$114.82	$204.17	$794.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $316.23 / $1,905.46	Professional	TC	$213.80	$316.23	$1,905.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $891.25 / $1,148.15 / $1,148.15	Facility	26	$891.25	$1,148.15	$1,148.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $776.25 / $3,890.45	Professional		$457.09	$776.25	$3,890.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $186.21 / $776.25	Professional	26	$128.82	$186.21	$776.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $501.19 / $3,311.31	Professional	TC	$295.12	$501.19	$3,311.31
Midlands Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,148.15 / $1,318.26	Professional		$724.44	$1,148.15	$1,318.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $281.84 / $416.87	Professional	26	$245.47	$281.84	$416.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $794.33 / $1,047.13	Professional	TC	$489.78	$794.33	$1,047.13
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $407.38 / $407.38 / $407.38	Facility	26	$407.38	$407.38	$407.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $851.14 / $1,318.26	Professional		$831.76	$851.14	$1,318.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $263.03 / $371.54	Professional	26	$245.47	$263.03	$371.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $575.44 / $1,047.13	Professional	TC	$562.34	$575.44	$1,047.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $269.15 / $616.60	Professional		$123.03	$269.15	$616.60
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $630.96 / $1,230.27	Professional		$416.87	$630.96	$1,230.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $177.83 / $380.19	Professional	26	$128.82	$177.83	$380.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $457.09 / $870.96	Professional	TC	$295.12	$457.09	$870.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $954.99	Professional		$812.83	$812.83	$954.99
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $269.15 / $316.23	Professional	26	$269.15	$269.15	$316.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $549.54 / $645.65	Professional	TC	$549.54	$549.54	$645.65