Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $162.18 / $645.65	Professional		$85.11	$162.18	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $169.82 / $724.44	Professional	26	$38.02	$169.82	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $70.79 / $154.88	Professional	TC	$46.77	$70.79	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $218.78 / $380.19	Professional		$81.28	$218.78	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $138.04	Professional	26	$44.67	$77.62	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $141.25 / $199.53	Professional	TC	$40.74	$141.25	$199.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $346.74	Professional		$151.36	$186.21	$346.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $181.97	Professional	26	$53.70	$95.50	$181.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $97.72 / $169.82	Professional	TC	$75.86	$97.72	$169.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $181.97 / $398.11	Facility		$131.83	$181.97	$398.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $223.87 / $223.87 / $223.87	Facility	26	$223.87	$223.87	$223.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $218.78 / $758.58	Professional		$117.49	$218.78	$758.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $70.79 / $309.03	Professional	26	$42.66	$70.79	$309.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $147.91 / $512.86	Professional	TC	$64.57	$147.91	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $389.05	Professional		$138.04	$218.78	$389.05
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $81.28 / $194.98	Professional	26	$47.86	$81.28	$194.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $141.25 / $251.19	Professional	TC	$91.20	$141.25	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $239.88 / $239.88	Professional		$177.83	$239.88	$239.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $109.65	Professional	26	$75.86	$85.11	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $154.88 / $154.88	Professional	TC	$102.33	$154.88	$154.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $112.20 / $223.87	Professional		$40.74	$112.20	$223.87
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $128.82 / $346.74	Professional		$117.49	$128.82	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $44.67 / $151.36	Professional	26	$42.66	$44.67	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $81.28 / $194.98	Professional	TC	$75.86	$81.28	$194.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $239.88 / $281.84	Professional		$204.17	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $79.43 / $93.33	Professional	26	$67.61	$79.43	$93.33
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $186.21	Professional	TC	$134.90	$158.49	$186.21