Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $117.49 / $208.93	Facility	26	$54.95	$117.49	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $478.63 / $1,318.26	Professional		$380.19	$478.63	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $269.15	Professional	26	$53.70	$75.86	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $380.19 / $870.96	Professional	TC	$323.59	$380.19	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $954.99 / $1,148.15	Professional		$776.25	$954.99	$1,148.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $151.36	Professional	26	$109.65	$128.82	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $812.83 / $1,000.00	Professional	TC	$588.84	$812.83	$1,000.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $602.56 / $1,995.26	Professional		$380.19	$602.56	$1,995.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $95.50 / $263.03	Professional	26	$54.95	$95.50	$263.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $562.34 / $1,698.24	Professional	TC	$323.59	$562.34	$1,698.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $416.87 / $416.87 / $416.87	Facility	26	$416.87	$416.87	$416.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $891.25 / $3,890.45	Professional		$467.74	$891.25	$3,890.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $131.83 / $616.60	Professional	26	$74.13	$131.83	$616.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $407.38 / $758.58 / $3,548.13	Professional	TC	$407.38	$758.58	$3,548.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,047.13 / $1,174.90	Professional		$794.33	$1,047.13	$1,174.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $147.91 / $199.53	Professional	26	$131.83	$147.91	$199.53
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $891.25 / $1,000.00	Professional	TC	$676.08	$891.25	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $831.76 / $1,096.48	Professional		$776.25	$831.76	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $120.23 / $154.88	Professional	26	$109.65	$120.23	$154.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $707.95 / $954.99	Professional	TC	$660.69	$707.95	$954.99
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $446.68 / $954.99	Professional		$60.26	$446.68	$954.99
United Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $776.25 / $1,148.15	Professional		$426.58	$776.25	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $123.03 / $173.78	Professional	26	$64.57	$123.03	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $660.69 / $912.01	Professional	TC	$363.08	$660.69	$912.01
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $870.96 / $1,023.29	Professional		$870.96	$870.96	$1,023.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $131.83	Professional	26	$112.20	$112.20	$131.83
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $758.58 / $891.25	Professional	TC	$758.58	$758.58	$891.25