Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $154.88 / $309.03	Facility	26	$100.00	$154.88	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $478.63 / $2,089.30	Professional		$354.81	$478.63	$2,089.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $186.21 / $467.74	Professional	26	$97.72	$186.21	$467.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $1,548.82	Professional	TC	$245.47	$354.81	$1,548.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $346.74 / $363.08 / $371.54	Facility	26	$346.74	$363.08	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $977.24 / $1,230.27	Professional		$851.14	$977.24	$1,230.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $251.19 / $309.03	Professional	26	$223.87	$251.19	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $724.44 / $912.01	Professional	TC	$630.96	$724.44	$912.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $602.56 / $1,548.82	Professional		$354.81	$602.56	$1,548.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $177.83 / $354.81	Professional	26	$107.15	$177.83	$354.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $398.11 / $1,047.13	Professional	TC	$288.40	$398.11	$1,047.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $363.08 / $363.08 / $478.63	Facility	26	$363.08	$363.08	$478.63
Medica Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $691.83 / $1,380.38	Professional		$467.74	$691.83	$1,380.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $134.90 / $426.58	Professional	26	$112.20	$134.90	$426.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $416.87 / $1,348.96	Professional	TC	$346.74	$416.87	$1,348.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $851.14 / $1,548.82	Professional		$794.33	$851.14	$1,548.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $223.87 / $389.05	Professional	26	$204.17	$223.87	$389.05
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $630.96 / $1,174.90	Professional	TC	$588.84	$630.96	$1,174.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $371.54 / $371.54 / $371.54	Facility	26	$371.54	$371.54	$371.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $954.99 / $1,096.48	Professional		$954.99	$954.99	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $245.47 / $275.42	Professional	26	$245.47	$245.47	$275.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $691.83 / $812.83	Professional	TC	$691.83	$691.83	$812.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $309.03 / $676.08	Professional		$107.15	$309.03	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $549.54 / $954.99	Professional		$467.74	$549.54	$954.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $134.90 / $234.42	Professional	26	$114.82	$134.90	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $416.87 / $724.44	Professional	TC	$346.74	$416.87	$724.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $741.31 / $870.96	Professional		$588.84	$741.31	$870.96
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $194.98 / $229.09	Professional	26	$154.88	$194.98	$229.09
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $549.54 / $645.65	Professional	TC	$436.52	$549.54	$645.65