Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $489.78	Facility	26	$83.18	$83.18	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $147.91 / $812.83	Professional		$112.20	$147.91	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $56.23 / $346.74	Professional	TC	$38.02	$56.23	$346.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $316.23 / $331.13 / $338.84	Facility	26	$316.23	$331.13	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $346.74 / $436.52	Professional		$338.84	$346.74	$436.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $128.82 / $162.18	Professional	TC	$114.82	$128.82	$162.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $616.60	Professional		$147.91	$239.88	$616.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $158.49 / $389.05	Professional	26	$95.50	$158.49	$389.05
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $85.11 / $281.84	Professional	TC	$52.48	$85.11	$281.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $331.13 / $331.13 / $426.58	Facility	26	$331.13	$331.13	$426.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $707.95	Professional		$147.91	$245.47	$707.95
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $588.84	Professional	TC	$46.77	$61.66	$588.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $338.84 / $724.44	Professional		$288.40	$338.84	$724.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $213.80 / $354.81	Professional	26	$186.21	$213.80	$354.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $114.82 / $363.08	Professional	TC	$102.33	$114.82	$363.08
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $338.84 / $338.84 / $338.84	Facility	26	$338.84	$338.84	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $338.84 / $398.11	Professional		$338.84	$338.84	$398.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $125.89 / $144.54	Professional	TC	$125.89	$125.89	$144.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $104.71 / $251.19	Professional		$52.48	$104.71	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $181.97 / $346.74	Professional		$144.54	$181.97	$346.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $60.26 / $120.23	Professional	TC	$46.77	$60.26	$120.23
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $251.19 / $295.12	Professional		$194.98	$251.19	$295.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $91.20 / $107.15	Professional	TC	$72.44	$91.20	$107.15