Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $141.25 / $354.81	Facility	26	$77.62	$141.25	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $389.05 / $1,174.90	Professional		$229.09	$389.05	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $131.83 / $501.19	Professional	26	$77.62	$131.83	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $371.54	Professional	TC	$138.04	$173.78	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $501.19 / $645.65	Professional		$309.03	$501.19	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $173.78 / $234.42	Professional	26	$112.20	$173.78	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $323.59 / $416.87	Professional	TC	$190.55	$323.59	$416.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $371.54 / $1,023.29	Professional		$208.93	$371.54	$1,023.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $138.04 / $354.81	Professional	26	$77.62	$138.04	$354.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $239.88 / $676.08	Professional	TC	$134.90	$239.88	$676.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $363.08 / $363.08 / $363.08	Facility	26	$363.08	$363.08	$363.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $446.68 / $2,398.83	Professional		$245.47	$446.68	$2,398.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $144.54 / $524.81	Professional	26	$87.10	$144.54	$524.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $223.87 / $977.24	Professional	TC	$151.36	$223.87	$977.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $537.03 / $645.65	Professional		$446.68	$537.03	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $204.17 / $223.87	Professional	26	$162.18	$204.17	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $354.81 / $416.87	Professional	TC	$275.42	$354.81	$416.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $588.84 / $645.65	Professional		$446.68	$588.84	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $208.93 / $223.87	Professional	26	$158.49	$208.93	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $389.05 / $416.87	Professional	TC	$288.40	$389.05	$416.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $218.78 / $467.74	Professional		$85.11	$218.78	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $346.74 / $630.96	Professional		$239.88	$346.74	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $131.83 / $239.88	Professional	26	$87.10	$131.83	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $208.93 / $389.05	Professional	TC	$151.36	$208.93	$389.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $537.03	Professional		$457.09	$457.09	$537.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $162.18 / $190.55	Professional	26	$162.18	$162.18	$190.55
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $346.74	Professional	TC	$295.12	$295.12	$346.74