Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $338.84 / $660.69	Facility	26	$213.80	$338.84	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $602.56 / $2,511.89	Professional		$389.05	$602.56	$2,511.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $457.09 / $1,122.02	Professional	26	$208.93	$457.09	$1,122.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $295.12 / $1,479.11	Professional	TC	$190.55	$295.12	$1,479.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $676.08 / $691.83 / $707.95	Facility	26	$676.08	$691.83	$707.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,148.15 / $1,412.54	Professional		$1,023.29	$1,148.15	$1,412.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $489.78 / $537.03 / $676.08	Professional	26	$489.78	$537.03	$676.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $602.56 / $758.58	Professional	TC	$524.81	$602.56	$758.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $724.44 / $1,778.28	Professional		$426.58	$724.44	$1,778.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $380.19 / $1,621.81	Professional	26	$234.42	$380.19	$1,621.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $331.13 / $1,096.48	Professional	TC	$213.80	$331.13	$1,096.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $691.83 / $691.83 / $1,023.29	Facility	26	$691.83	$691.83	$1,023.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $776.25 / $1,584.89	Professional		$524.81	$776.25	$1,584.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $295.12 / $933.25	Professional	26	$239.88	$295.12	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $316.23 / $1,258.93	Professional	TC	$263.03	$316.23	$1,258.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,023.29 / $1,621.81	Professional		$912.01	$1,023.29	$1,621.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $489.78 / $776.25	Professional	26	$446.68	$489.78	$776.25
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $524.81 / $851.14	Professional	TC	$467.74	$524.81	$851.14
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,230.27	Professional		$1,122.02	$1,122.02	$1,230.27
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $602.56	Professional	26	$537.03	$537.03	$602.56
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $588.84 / $645.65	Professional	TC	$588.84	$588.84	$645.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $416.87 / $812.83	Professional		$229.09	$416.87	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $602.56 / $1,047.13	Professional		$512.86	$602.56	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $288.40 / $501.19	Professional	26	$245.47	$288.40	$501.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $316.23 / $537.03	Professional	TC	$263.03	$316.23	$537.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $870.96 / $1,023.29	Professional		$691.83	$870.96	$1,023.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $416.87 / $489.78	Professional	26	$331.13	$416.87	$489.78
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $457.09 / $537.03	Professional	TC	$363.08	$457.09	$537.03