Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $70.79 / $85.11	Facility	26	$34.67	$70.79	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $354.81 / $1,288.25	Professional		$234.42	$354.81	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $56.23 / $147.91	Professional	26	$34.67	$56.23	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $239.88 / $741.31	Professional	TC	$186.21	$239.88	$741.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $128.82 / $131.83	Facility	26	$125.89	$128.82	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $630.96 / $794.33	Professional		$602.56	$630.96	$794.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $100.00 / $114.82	Professional	26	$93.33	$100.00	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $549.54 / $676.08	Professional	TC	$512.86	$549.54	$676.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $354.81 / $741.31	Professional		$229.09	$354.81	$741.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $67.61 / $138.04	Professional	26	$40.74	$67.61	$138.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $323.59 / $645.65	Professional	TC	$190.55	$323.59	$645.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $223.87	Facility	26	$128.82	$128.82	$223.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $891.25	Professional		$239.88	$436.52	$891.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $331.13	Professional	26	$40.74	$50.12	$331.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $275.42 / $1,548.82	Professional	TC	$169.82	$275.42	$1,548.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $562.34 / $741.31	Professional		$524.81	$562.34	$741.31
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $100.00 / $154.88	Professional	26	$79.43	$100.00	$154.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $478.63 / $602.56	Professional	TC	$426.58	$478.63	$602.56
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Facility	26	$131.83	$131.83	$131.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $616.60 / $691.83	Professional		$616.60	$616.60	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $100.00	Professional	26	$93.33	$93.33	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $524.81 / $588.84	Professional	TC	$524.81	$524.81	$588.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $229.09 / $478.63	Professional		$39.81	$229.09	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $323.59 / $676.08	Professional		$223.87	$323.59	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $47.86 / $107.15	Professional	26	$41.69	$47.86	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $275.42 / $575.44	Professional	TC	$181.97	$275.42	$575.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $457.09 / $537.03	Professional		$354.81	$457.09	$537.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $67.61 / $79.43	Professional	26	$53.70	$67.61	$79.43
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $380.19 / $457.09	Professional	TC	$302.00	$380.19	$457.09