Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $34.67 / $213.80	Facility	26	$34.67	$34.67	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $213.80	Professional		$83.18	$104.71	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $64.57 / $128.82	Professional	TC	$52.48	$64.57	$128.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $128.82 / $131.83	Facility	26	$123.03	$128.82	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $257.04 / $323.59	Professional		$131.83	$257.04	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $165.96 / $223.87	Professional	TC	$91.20	$165.96	$223.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $186.21 / $602.56	Professional		$97.72	$186.21	$602.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $64.57 / $245.47	Professional	26	$37.15	$64.57	$245.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $117.49 / $398.11	Professional	TC	$61.66	$117.49	$398.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $181.97 / $181.97	Facility	26	$93.33	$181.97	$181.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $199.53 / $1,122.02	Professional		$107.15	$199.53	$1,122.02
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $104.71 / $912.01	Professional	TC	$56.23	$104.71	$912.01
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $269.15 / $323.59	Professional		$213.80	$269.15	$323.59
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $93.33 / $128.82	Professional	26	$79.43	$93.33	$128.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $165.96 / $234.42	Professional	TC	$123.03	$165.96	$234.42
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Facility	26	$131.83	$131.83	$131.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $251.19 / $323.59	Professional		$181.97	$251.19	$323.59
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $162.18 / $234.42	Professional	TC	$97.72	$162.18	$234.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $87.10 / $186.21	Professional		$41.69	$87.10	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $141.25 / $234.42	Professional		$97.72	$141.25	$234.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $85.11 / $151.36	Professional	TC	$56.23	$85.11	$151.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $218.78	Professional		$186.21	$186.21	$218.78
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $138.04	Professional	TC	$117.49	$117.49	$138.04