Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $109.65 / $177.83	Facility	26	$77.62	$109.65	$177.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $295.12 / $1,479.11	Professional		$223.87	$295.12	$1,479.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $100.00 / $426.58	Professional	26	$72.44	$100.00	$426.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $204.17 / $416.87	Professional	TC	$141.25	$204.17	$416.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $263.03 / $269.15	Facility	26	$257.04	$263.03	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $549.54 / $691.83	Professional		$316.23	$549.54	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $190.55 / $239.88	Professional	26	$107.15	$190.55	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $363.08 / $457.09	Professional	TC	$208.93	$363.08	$457.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $346.74 / $1,202.26	Professional		$204.17	$346.74	$1,202.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $138.04 / $398.11	Professional	26	$75.86	$138.04	$398.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $660.69	Professional	TC	$131.83	$194.98	$660.69
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $776.25 / $776.25	Facility	26	$588.84	$776.25	$776.25
Medica Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $436.52 / $1,513.56	Professional		$257.04	$436.52	$1,513.56
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $120.23 / $524.81	Professional	26	$85.11	$120.23	$524.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $1,000.00	Professional	TC	$162.18	$245.47	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $549.54 / $776.25	Professional		$457.09	$549.54	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $190.55 / $239.88	Professional	26	$165.96	$190.55	$239.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $354.81 / $537.03	Professional	TC	$295.12	$354.81	$537.03
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $549.54 / $776.25	Professional		$537.03	$549.54	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $177.83 / $239.88	Professional	26	$162.18	$177.83	$239.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $380.19 / $537.03	Professional	TC	$354.81	$380.19	$537.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $173.78 / $389.05	Professional		$83.18	$173.78	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $302.00 / $602.56	Professional		$245.47	$302.00	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $107.15 / $218.78	Professional	26	$85.11	$107.15	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $407.38	Professional	TC	$154.88	$208.93	$407.38
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $446.68 / $524.81	Professional		$446.68	$446.68	$524.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $154.88 / $186.21	Professional	26	$154.88	$154.88	$186.21
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $338.84	Professional	TC	$288.40	$288.40	$338.84