Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $389.05 / $501.19	Facility	26	$257.04	$389.05	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $407.38 / $1,288.25	Professional		$269.15	$407.38	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $223.87 / $794.33	Professional	26	$165.96	$223.87	$794.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $251.19	Professional	TC	$93.33	$114.82	$251.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $616.60 / $758.58	Professional		$489.78	$616.60	$758.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $309.03 / $398.11 / $489.78	Professional	26	$309.03	$398.11	$489.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $223.87 / $281.84	Professional	TC	$177.83	$223.87	$281.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $398.11 / $1,258.93	Professional		$257.04	$398.11	$1,258.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $245.47 / $741.31	Professional	26	$173.78	$245.47	$741.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $128.82 / $776.25	Professional	TC	$93.33	$128.82	$776.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $831.76 / $831.76 / $831.76	Facility	26	$831.76	$831.76	$831.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $602.56 / $1,862.09	Professional		$354.81	$602.56	$1,862.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $371.54 / $1,174.90	Professional	26	$218.78	$371.54	$1,174.90
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $208.93 / $691.83	Professional	TC	$131.83	$208.93	$691.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $707.95 / $724.44	Professional		$588.84	$707.95	$724.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $436.52 / $467.74	Professional	26	$371.54	$436.52	$467.74
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $257.04 / $281.84	Professional	TC	$213.80	$257.04	$281.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $588.84 / $776.25	Professional		$524.81	$588.84	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $389.05 / $489.78	Professional	26	$323.59	$389.05	$489.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $208.93 / $275.42	Professional	TC	$204.17	$208.93	$275.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $288.40 / $602.56	Professional		$114.82	$288.40	$602.56
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $512.86 / $912.01	Professional		$323.59	$512.86	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $323.59 / $575.44	Professional	26	$204.17	$323.59	$575.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $323.59	Professional	TC	$114.82	$190.55	$323.59
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $562.34 / $660.69	Professional		$562.34	$562.34	$660.69
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $363.08 / $426.58	Professional	26	$363.08	$363.08	$426.58
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $199.53 / $234.42	Professional	TC	$199.53	$199.53	$234.42