Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $398.11 / $977.24	Professional		$316.23	$398.11	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $269.15 / $776.25	Professional	26	$112.20	$269.15	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $251.19 / $467.74	Professional	TC	$177.83	$251.19	$467.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $707.95 / $954.99	Professional		$199.53	$707.95	$954.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $263.03 / $407.38	Professional	26	$93.33	$263.03	$407.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $363.08 / $588.84	Professional	TC	$83.18	$363.08	$588.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $549.54 / $1,096.48	Professional		$354.81	$549.54	$1,096.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $213.80 / $660.69	Professional	26	$147.91	$213.80	$660.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $354.81 / $616.60	Professional	TC	$131.83	$354.81	$616.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	26	$630.96	$630.96	$630.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $741.31 / $2,754.23	Professional		$346.74	$741.31	$2,754.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $269.15 / $891.25	Professional	26	$141.25	$269.15	$891.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $467.74 / $1,862.09	Professional	TC	$204.17	$467.74	$1,862.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $741.31 / $891.25	Professional		$501.19	$741.31	$891.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $269.15 / $363.08	Professional	26	$165.96	$269.15	$363.08
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $457.09 / $575.44	Professional	TC	$295.12	$457.09	$575.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $776.25 / $776.25	Professional		$524.81	$776.25	$776.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $295.12 / $295.12	Professional	26	$263.03	$295.12	$295.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $478.63 / $478.63	Professional	TC	$245.47	$478.63	$478.63
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $389.05 / $776.25	Professional		$141.25	$389.05	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $426.58 / $1,071.52	Professional		$380.19	$426.58	$1,071.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $151.36 / $416.87	Professional	26	$147.91	$151.36	$416.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $269.15 / $588.84	Professional	TC	$234.42	$269.15	$588.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $851.14 / $1,000.00	Professional		$724.44	$851.14	$1,000.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $281.84 / $331.13	Professional	26	$239.88	$281.84	$331.13
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $575.44 / $676.08	Professional	TC	$489.78	$575.44	$676.08