Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $102.33 / $154.88	Facility	26	$67.61	$102.33	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $616.60 / $2,691.53	Professional		$380.19	$616.60	$2,691.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $87.10 / $281.84	Professional	26	$69.18	$87.10	$281.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $407.38 / $870.96	Professional	TC	$302.00	$407.38	$870.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $234.42 / $245.47 / $251.19	Facility	26	$234.42	$245.47	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,023.29 / $1,258.93	Professional		$954.99	$1,023.29	$1,258.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $173.78 / $218.78	Professional	26	$165.96	$173.78	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $851.14 / $1,047.13	Professional	TC	$794.33	$851.14	$1,047.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $575.44 / $1,621.81	Professional		$363.08	$575.44	$1,621.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $112.20 / $288.40	Professional	26	$69.18	$112.20	$288.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $501.19 / $1,348.96	Professional	TC	$295.12	$501.19	$1,348.96
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $338.84	Facility	26	$245.47	$245.47	$338.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $776.25 / $1,445.44	Professional		$467.74	$776.25	$1,445.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $117.49 / $478.63	Professional	26	$77.62	$117.49	$478.63
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $489.78 / $2,290.87	Professional	TC	$363.08	$489.78	$2,290.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $891.25 / $1,288.25	Professional		$831.76	$891.25	$1,288.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $158.49 / $275.42	Professional	26	$151.36	$158.49	$275.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $741.31 / $1,000.00	Professional	TC	$691.83	$741.31	$1,000.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,096.48	Professional		$1,000.00	$1,000.00	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $173.78 / $186.21	Professional	26	$173.78	$173.78	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $812.83 / $812.83 / $912.01	Professional	TC	$812.83	$812.83	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $363.08 / $776.25	Professional		$77.62	$363.08	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $575.44 / $1,122.02	Professional		$446.68	$575.44	$1,122.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $102.33 / $199.53	Professional	26	$77.62	$102.33	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $478.63 / $933.25	Professional	TC	$363.08	$478.63	$933.25
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $724.44 / $851.14	Professional		$575.44	$724.44	$851.14
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $125.89 / $151.36	Professional	26	$100.00	$125.89	$151.36
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $588.84 / $691.83	Professional	TC	$467.74	$588.84	$691.83