Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $72.44 / $97.72	Facility	26	$67.61	$72.44	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $537.03 / $2,344.23	Professional		$323.59	$537.03	$2,344.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $295.12	Professional	26	$69.18	$89.13	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $363.08 / $812.83	Professional	TC	$229.09	$363.08	$812.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $234.42 / $239.88 / $245.47	Facility	26	$234.42	$239.88	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $933.25 / $1,174.90	Professional		$933.25	$933.25	$1,174.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $169.82 / $213.80	Professional	26	$158.49	$169.82	$213.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $776.25 / $954.99	Professional	TC	$776.25	$776.25	$954.99
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $575.44 / $1,819.70	Professional		$338.84	$575.44	$1,819.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $109.65 / $288.40	Professional	26	$74.13	$109.65	$288.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $457.09 / $1,584.89	Professional	TC	$309.03	$457.09	$1,584.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $239.88 / $331.13	Facility	26	$239.88	$239.88	$331.13
Medica Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $602.56 / $1,318.26	Professional		$380.19	$602.56	$1,318.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $91.20 / $281.84	Professional	26	$75.86	$91.20	$281.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $380.19 / $1,000.00	Professional	TC	$295.12	$380.19	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $831.76 / $1,621.81	Professional		$776.25	$831.76	$1,621.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $158.49 / $309.03	Professional	26	$147.91	$158.49	$309.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $676.08 / $1,288.25	Professional	TC	$630.96	$676.08	$1,288.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Facility	26	$245.47	$245.47	$245.47
Midlands Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $912.01 / $1,023.29	Professional		$912.01	$912.01	$1,023.29
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $169.82 / $181.97	Professional	26	$169.82	$169.82	$181.97
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $741.31 / $831.76	Professional	TC	$741.31	$741.31	$831.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $323.59 / $691.83	Professional		$74.13	$323.59	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $489.78 / $1,071.52	Professional		$380.19	$489.78	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $91.20 / $194.98	Professional	26	$75.86	$91.20	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $398.11 / $851.14	Professional	TC	$295.12	$398.11	$851.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $660.69 / $776.25	Professional		$524.81	$660.69	$776.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $123.03 / $144.54	Professional	26	$97.72	$123.03	$144.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $537.03 / $630.96	Professional	TC	$426.58	$537.03	$630.96