Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $67.61 / $104.71	Facility	26	$67.61	$67.61	$104.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $1,445.44	Professional		$194.98	$281.84	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $112.20 / $446.68	Professional	26	$64.57	$112.20	$446.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $158.49 / $371.54	Professional	TC	$125.89	$158.49	$371.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $223.87 / $234.42 / $239.88	Facility	26	$223.87	$234.42	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $537.03 / $660.69	Professional		$302.00	$537.03	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $173.78 / $218.78	Professional	26	$95.50	$173.78	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $354.81 / $446.68	Professional	TC	$194.98	$354.81	$446.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $1,288.25	Professional		$218.78	$363.08	$1,288.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $102.33 / $398.11	Professional	26	$70.79	$102.33	$398.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $190.55 / $660.69	Professional	TC	$131.83	$190.55	$660.69
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $707.95 / $707.95	Facility	26	$549.54	$707.95	$707.95
Medica Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $575.44 / $1,479.11	Professional		$269.15	$575.44	$1,479.11
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $117.49 / $478.63	Professional	26	$77.62	$117.49	$478.63
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $489.78 / $1,000.00	Professional	TC	$173.78	$489.78	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $537.03 / $691.83	Professional		$436.52	$537.03	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $173.78 / $229.09	Professional	26	$147.91	$173.78	$229.09
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $363.08 / $467.74	Professional	TC	$288.40	$363.08	$467.74
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $239.88 / $239.88	Facility	26	$239.88	$239.88	$239.88
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $524.81 / $954.99	Professional		$436.52	$524.81	$954.99
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $177.83 / $316.23	Professional	26	$151.36	$177.83	$316.23
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $346.74 / $645.65	Professional	TC	$288.40	$346.74	$645.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $158.49 / $371.54	Professional		$75.86	$158.49	$371.54
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $416.87 / $933.25	Professional		$251.19	$416.87	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $239.88	Professional	26	$77.62	$109.65	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $275.42 / $831.76	Professional	TC	$169.82	$275.42	$831.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $588.84	Professional		$489.78	$489.78	$588.84
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 $331.13 / $331.13 / $389.05	Professional	TC	$331.13	$331.13	$389.05