Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $61.66 / $74.13	Facility	26	$30.90	$61.66	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $346.74 / $1,737.80	Professional		$257.04	$346.74	$1,737.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $72.44 / $125.89	Professional	26	$30.90	$72.44	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $831.76	Professional	TC	$213.80	$281.84	$831.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $109.65 / $112.20	Facility	26	$107.15	$109.65	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $707.95 / $870.96	Professional		$707.95	$707.95	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $81.28 / $100.00	Professional	26	$79.43	$81.28	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $630.96 / $776.25	Professional	TC	$616.60	$630.96	$776.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $426.58 / $912.01	Professional		$251.19	$426.58	$912.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $102.33	Professional	26	$32.36	$52.48	$102.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $831.76	Professional	TC	$251.19	$371.54	$831.76
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $154.88	Facility	26	$109.65	$109.65	$154.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $537.03 / $1,000.00	Professional		$309.03	$537.03	$1,000.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $42.66 / $125.89	Professional	26	$34.67	$42.66	$125.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $323.59 / $1,047.13	Professional	TC	$269.15	$323.59	$1,047.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $707.95 / $1,202.26	Professional		$575.44	$707.95	$1,202.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $141.25	Professional	26	$69.18	$81.28	$141.25
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $630.96 / $1,071.52	Professional	TC	$501.19	$630.96	$1,071.52
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $776.25	Professional		$676.08	$676.08	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $81.28 / $87.10	Professional	26	$81.28	$81.28	$87.10
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $676.08	Professional	TC	$602.56	$602.56	$676.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $257.04 / $524.81	Professional		$35.48	$257.04	$524.81
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $371.54 / $794.33	Professional		$309.03	$371.54	$794.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $40.74 / $91.20	Professional	26	$35.48	$40.74	$91.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $323.59 / $691.83	Professional	TC	$275.42	$323.59	$691.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $501.19 / $588.84	Professional		$389.05	$501.19	$588.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $69.18	Professional	26	$46.77	$58.88	$69.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $436.52 / $512.86	Professional	TC	$346.74	$436.52	$512.86