Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $57.54 / $91.20	Professional		$41.69	$57.54	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.95 / $33.88	Professional	26	$15.14	$19.95	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $56.23	Professional	TC	$25.70	$36.31	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $120.23 / $177.83	Professional		$46.77	$120.23	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $42.66 / $67.61	Professional	26	$16.22	$42.66	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $75.86 / $112.20	Professional	TC	$30.90	$75.86	$112.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $104.71 / $354.81	Professional		$51.29	$104.71	$354.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $40.74 / $234.42	Professional	26	$19.50	$40.74	$234.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $64.57 / $125.89	Professional	TC	$30.90	$64.57	$125.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $120.23 / $436.52	Professional		$57.54	$120.23	$436.52
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $41.69 / $158.49	Professional	26	$21.38	$41.69	$158.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $69.18 / $281.84	Professional	TC	$36.31	$69.18	$281.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $120.23 / $223.87	Professional		$77.62	$120.23	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $42.66 / $83.18	Professional	26	$29.51	$42.66	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $79.43 / $141.25	Professional	TC	$47.86	$79.43	$141.25
Midlands Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $141.25 / $141.25	Professional		$120.23	$141.25	$141.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $54.95	Professional	26	$42.66	$54.95	$54.95
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $87.10 / $87.10	Professional	TC	$79.43	$87.10	$87.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $60.26 / $120.23	Professional		$25.12	$60.26	$120.23
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $75.86 / $186.21	Professional		$69.18	$75.86	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $27.54 / $69.18	Professional	26	$26.92	$27.54	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $46.77 / $114.82	Professional	TC	$42.66	$46.77	$114.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $131.83 / $154.88	Professional		$112.20	$131.83	$154.88
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $48.98 / $57.54	Professional	26	$41.69	$48.98	$57.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $83.18 / $97.72	Professional	TC	$70.79	$83.18	$97.72