Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $223.87 / $758.58	Facility	26	$186.21	$223.87	$758.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $457.09 / $1,445.44	Professional		$354.81	$457.09	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $151.36 / $389.05	Professional	26	$128.82	$151.36	$389.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $295.12 / $1,513.56	Professional	TC	$213.80	$295.12	$1,513.56
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 $891.25 / $1,122.02 / $1,380.38	Professional		$891.25	$1,122.02	$1,380.38
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 $588.84 / $758.58 / $933.25	Professional	TC	$588.84	$758.58	$933.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $691.83 / $1,778.28	Professional		$457.09	$691.83	$1,778.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $218.78 / $645.65	Professional	26	$190.55	$218.78	$645.65
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $354.81 / $416.87 / $812.83	Professional	TC	$354.81	$416.87	$812.83
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 $416.87 / $575.44 / $1,288.25	Professional		$416.87	$575.44	$1,288.25
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 $229.09 / $281.84 / $831.76	Professional	TC	$229.09	$281.84	$831.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,000.00 / $1,318.26	Professional		$660.69	$1,000.00	$1,318.26
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 $363.08 / $660.69 / $812.83	Professional	TC	$363.08	$660.69	$812.83
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 $1,096.48 / $1,096.48 / $1,230.27	Professional		$1,096.48	$1,096.48	$1,230.27
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 $724.44 / $724.44 / $812.83	Professional	TC	$724.44	$724.44	$812.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $338.84 / $776.25	Professional		$158.49	$338.84	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $478.63 / $870.96	Professional		$416.87	$478.63	$870.96
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 $234.42 / $281.84 / $537.03	Professional	TC	$234.42	$281.84	$537.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $851.14 / $1,000.00	Professional		$676.08	$851.14	$1,000.00
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 $457.09 / $575.44 / $676.08	Professional	TC	$457.09	$575.44	$676.08