Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.34 / $230.43 / $484.51	Facility		$75.34	$230.43	$484.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.36 / $9.63 / $17.80	Facility	26	$9.36	$9.63	$17.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.86 / $234.22 / $356.49	Facility	TC	$37.86	$234.22	$356.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.58 / $37.57 / $136.80	Professional		$27.58	$37.57	$136.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.46 / $12.45 / $43.63	Professional	26	$9.46	$12.45	$43.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.57 / $23.51 / $73.31	Professional	TC	$19.57	$23.51	$73.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $95.94 / $98.82 / $101.70	Facility		$95.94	$98.82	$101.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.59 / $35.63 / $36.67	Facility	26	$34.59	$35.63	$36.67
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $61.35 / $63.19 / $65.03	Facility	TC	$61.35	$63.19	$65.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.85 / $78.34 / $97.93	Professional		$31.85	$78.34	$97.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $23.27 / $29.09	Professional	26	$10.42	$23.27	$29.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.84 / $55.07 / $68.84	Professional	TC	$19.84	$55.07	$68.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.17 / $46.08 / $118.15	Professional		$33.17	$46.08	$118.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.63 / $14.88 / $40.15	Professional	26	$10.63	$14.88	$40.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.58 / $31.20 / $68.89	Professional	TC	$22.58	$31.20	$68.89
Medica Facility/Professional Facility Modifier Low / Median / High Price $36.69 / $98.82 / $293.25	Facility		$36.69	$98.82	$293.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $35.63 / $70.00 / $70.00	Facility	26	$35.63	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $94.48 / $105.96 / $175.50	Facility	TC	$94.48	$105.96	$175.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.50 / $52.77 / $212.91	Professional		$30.50	$52.77	$212.91
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.71 / $16.07 / $66.04	Professional	26	$10.71	$16.07	$66.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.34 / $25.77 / $149.15	Professional	TC	$19.34	$25.77	$149.15
Midlands Facility/Professional Facility Modifier Low / Median / High Price $36.83 / $65.69 / $114.35	Facility		$36.83	$65.69	$114.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $35.63 / $36.67 / $58.26	Facility	26	$35.63	$36.67	$58.26
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $63.19 / $65.03 / $124.92	Facility	TC	$63.19	$65.03	$124.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $56.13 / $71.38 / $111.75	Professional		$56.13	$71.38	$111.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.38 / $31.13 / $55.57	Professional		$10.38	$31.13	$55.57
United Facility/Professional Professional Modifier Low / Median / High Price $30.50 / $39.72 / $63.00	Professional		$30.50	$39.72	$63.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.73 / $13.95 / $31.96	Professional	26	$10.73	$13.95	$31.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.79 / $25.77 / $73.97	Professional	TC	$19.79	$25.77	$73.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $45.58 / $57.70 / $67.80	Professional		$45.58	$57.70	$67.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.98 / $17.70 / $20.80	Professional	26	$13.98	$17.70	$20.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $31.60 / $40.00 / $47.00	Professional	TC	$31.60	$40.00	$47.00