Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $61.66 / $97.72	Facility	26	$41.69	$61.66	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $251.19 / $891.25	Professional		$131.83	$251.19	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $66.07 / $165.96	Professional	26	$41.69	$66.07	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $512.86	Professional	TC	$95.50	$138.04	$512.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $158.49 / $162.18	Facility	26	$154.88	$158.49	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $380.19 / $478.63	Professional		$199.53	$380.19	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $109.65 / $138.04	Professional	26	$57.54	$109.65	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $269.15 / $338.84	Professional	TC	$144.54	$269.15	$338.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $213.80 / $741.31	Professional		$151.36	$213.80	$741.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $70.79 / $165.96	Professional	26	$47.86	$70.79	$165.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $162.18 / $616.60	Professional	TC	$109.65	$162.18	$616.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $213.80 / $213.80	Facility	26	$158.49	$213.80	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $288.40 / $1,023.29	Professional		$173.78	$288.40	$1,023.29
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $302.00	Professional	26	$48.98	$70.79	$302.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $151.36 / $724.44	Professional	TC	$112.20	$151.36	$724.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $380.19 / $549.54	Professional		$309.03	$380.19	$549.54
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $165.96	Professional	26	$93.33	$117.49	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $263.03 / $380.19	Professional	TC	$213.80	$263.03	$380.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $371.54 / $549.54	Professional		$331.13	$371.54	$549.54
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $109.65 / $165.96	Professional	26	$100.00	$109.65	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $263.03 / $380.19	Professional	TC	$229.09	$263.03	$380.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $114.82 / $269.15	Professional		$48.98	$114.82	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $204.17 / $371.54	Professional		$158.49	$204.17	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $114.82	Professional	26	$48.98	$61.66	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $141.25 / $263.03	Professional	TC	$109.65	$141.25	$263.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $346.74	Professional		$295.12	$295.12	$346.74
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $87.10 / $102.33	Professional	26	$87.10	$87.10	$102.33
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $204.17 / $245.47	Professional	TC	$204.17	$204.17	$245.47