Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $229.09 / $446.68	Facility	26	$144.54	$229.09	$446.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $1,584.89	Professional		$218.78	$331.13	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $234.42 / $794.33	Professional	26	$128.82	$234.42	$794.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $151.36 / $741.31	Professional	TC	$107.15	$151.36	$741.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $478.63 / $489.78 / $501.19	Facility	26	$478.63	$489.78	$501.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $691.83 / $870.96	Professional		$616.60	$691.83	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $363.08 / $457.09	Professional	26	$331.13	$363.08	$457.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $331.13 / $416.87	Professional	TC	$295.12	$331.13	$416.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $436.52 / $1,288.25	Professional		$288.40	$436.52	$1,288.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $257.04 / $630.96	Professional	26	$162.18	$257.04	$630.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $186.21 / $616.60	Professional	TC	$158.49	$186.21	$616.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $691.83	Facility	26	$489.78	$489.78	$691.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $416.87 / $1,000.00	Professional		$302.00	$416.87	$1,000.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $194.98 / $616.60	Professional	26	$162.18	$194.98	$616.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $165.96 / $549.54	Professional	TC	$138.04	$165.96	$549.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $616.60 / $1,071.52	Professional		$537.03	$616.60	$1,071.52
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $288.40 / $331.13 / $575.44	Professional	26	$288.40	$331.13	$575.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $295.12 / $489.78	Professional	TC	$245.47	$295.12	$489.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $776.25	Professional		$691.83	$691.83	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $363.08 / $407.38	Professional	26	$363.08	$363.08	$407.38
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $323.59 / $363.08	Professional	TC	$323.59	$323.59	$363.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $269.15 / $501.19	Professional		$138.04	$269.15	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $354.81 / $630.96	Professional		$302.00	$354.81	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $194.98 / $338.84	Professional	26	$165.96	$194.98	$338.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $165.96 / $281.84	Professional	TC	$138.04	$165.96	$281.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $537.03 / $630.96	Professional		$426.58	$537.03	$630.96
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $281.84 / $331.13	Professional	26	$223.87	$281.84	$331.13
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $257.04 / $302.00	Professional	TC	$199.53	$257.04	$302.00