Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.23 / $223.87	Professional		$85.11	$120.23	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $218.78	Professional	26	$30.20	$40.74	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $85.11 / $162.18	Professional	TC	$53.70	$85.11	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $275.42 / $478.63	Professional		$141.25	$275.42	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $79.43 / $138.04	Professional	26	$48.98	$79.43	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $186.21 / $257.04	Professional	TC	$85.11	$186.21	$257.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $489.78	Professional		$190.55	$234.42	$489.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $112.20 / $275.42	Professional	26	$54.95	$112.20	$275.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $144.54 / $263.03	Professional	TC	$107.15	$144.54	$263.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $263.03 / $1,071.52	Professional		$123.03	$263.03	$1,071.52
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $83.18 / $389.05	Professional	26	$41.69	$83.18	$389.05
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $162.18 / $794.33	Professional	TC	$81.28	$162.18	$794.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $363.08	Professional		$173.78	$269.15	$363.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $79.43 / $138.04	Professional	26	$48.98	$79.43	$138.04
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $245.47	Professional	TC	$123.03	$186.21	$245.47
Midlands Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $323.59	Professional		$239.88	$239.88	$323.59
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $134.90	Professional	26	$85.11	$85.11	$134.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $234.42	Professional	TC	$154.88	$154.88	$234.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $134.90 / $275.42	Professional		$41.69	$134.90	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $134.90 / $512.86	Professional		$123.03	$134.90	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $43.65 / $181.97	Professional	26	$41.69	$43.65	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $91.20 / $323.59	Professional	TC	$81.28	$91.20	$323.59
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $295.12 / $354.81	Professional		$251.19	$295.12	$354.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $95.50	Professional	26	$69.18	$81.28	$95.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $218.78 / $257.04	Professional	TC	$181.97	$218.78	$257.04