Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $346.74	Facility	26	$57.54	$57.54	$346.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $1,778.28	Professional		$257.04	$323.59	$1,778.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $64.57 / $257.04	Professional	26	$53.70	$64.57	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $257.04 / $616.60	Professional	TC	$204.17	$257.04	$616.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $204.17 / $213.80	Facility	26	$199.53	$204.17	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $933.25	Professional		$741.31	$741.31	$933.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $186.21	Professional	26	$147.91	$147.91	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $588.84 / $741.31	Professional	TC	$549.54	$588.84	$741.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $446.68 / $1,047.13	Professional		$263.03	$446.68	$1,047.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $97.72 / $194.98	Professional	26	$58.88	$97.72	$194.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $354.81 / $870.96	Professional	TC	$234.42	$354.81	$870.96
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $204.17 / $204.17 / $288.40	Facility	26	$204.17	$204.17	$288.40
Medica Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $562.34 / $1,047.13	Professional		$316.23	$562.34	$1,047.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $398.11	Professional	26	$66.07	$100.00	$398.11
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $331.13 / $1,479.11	Professional	TC	$245.47	$331.13	$1,479.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $741.31 / $794.33	Professional		$602.56	$741.31	$794.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $147.91 / $234.42	Professional	26	$128.82	$147.91	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $524.81 / $630.96	Professional	TC	$478.63	$524.81	$630.96
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $724.44 / $794.33	Professional		$724.44	$724.44	$794.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $158.49	Professional	26	$147.91	$147.91	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $575.44 / $630.96	Professional	TC	$575.44	$575.44	$630.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $257.04 / $549.54	Professional		$64.57	$257.04	$549.54
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $416.87 / $812.83	Professional		$316.23	$416.87	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $85.11 / $169.82	Professional	26	$66.07	$85.11	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $331.13 / $645.65	Professional	TC	$251.19	$331.13	$645.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $524.81 / $616.60	Professional		$416.87	$524.81	$616.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $107.15 / $125.89	Professional	26	$85.11	$107.15	$125.89
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $416.87 / $489.78	Professional	TC	$331.13	$416.87	$489.78