Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $263.03	Professional		$144.54	$199.53	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $104.71 / $501.19	Professional	26	$77.62	$104.71	$501.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $93.33 / $114.82	Professional	TC	$67.61	$93.33	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $436.52 / $676.08	Professional		$165.96	$436.52	$676.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $234.42 / $416.87	Professional	26	$120.23	$234.42	$416.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $218.78 / $316.23	Professional	TC	$45.71	$218.78	$316.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $380.19 / $467.74	Professional		$199.53	$380.19	$467.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $234.42 / $457.09	Professional	26	$97.72	$234.42	$457.09
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $7.94 / $169.82 / $363.08	Professional	TC	$7.94	$169.82	$363.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Facility	26	$575.44	$575.44	$575.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $467.74 / $1,548.82	Professional		$223.87	$467.74	$1,548.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $257.04 / $831.76	Professional	26	$125.89	$257.04	$831.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $190.55 / $794.33	Professional	TC	$95.50	$190.55	$794.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $676.08	Professional		$275.42	$478.63	$676.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $251.19 / $416.87	Professional	26	$141.25	$251.19	$416.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $234.42 / $288.40	Professional	TC	$134.90	$234.42	$288.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $426.58 / $575.44	Professional		$398.11	$426.58	$575.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $251.19 / $295.12	Professional	26	$186.21	$251.19	$295.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $177.83 / $275.42	Professional	TC	$177.83	$177.83	$275.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $213.80 / $416.87	Professional		$112.20	$213.80	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $239.88 / $758.58	Professional		$223.87	$239.88	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $134.90 / $371.54	Professional	26	$125.89	$134.90	$371.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $107.15 / $380.19	Professional	TC	$95.50	$107.15	$380.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $467.74 / $549.54	Professional		$398.11	$467.74	$549.54
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $234.42 / $275.42	Professional	26	$199.53	$234.42	$275.42
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $234.42 / $281.84	Professional	TC	$199.53	$234.42	$281.84