Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $19.95 / $123.03	Facility	26	$19.95	$19.95	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $125.89 / $323.59	Professional		$102.33	$125.89	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $107.15 / $234.42	Professional	TC	$85.11	$107.15	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $75.86 / $79.43	Facility	26	$74.13	$75.86	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $338.84 / $416.87	Professional		$147.91	$338.84	$416.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $281.84 / $354.81	Professional	TC	$117.49	$281.84	$354.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $181.97 / $281.84	Professional		$123.03	$181.97	$281.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $36.31 / $53.70	Professional	26	$21.38	$36.31	$53.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $151.36 / $239.88	Professional	TC	$100.00	$151.36	$239.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $104.71 / $104.71	Facility	26	$75.86	$104.71	$104.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $204.17 / $933.25	Professional		$114.82	$204.17	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $134.90 / $776.25	Professional	TC	$87.10	$134.90	$776.25
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $295.12 / $354.81	Professional		$213.80	$295.12	$354.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $52.48 / $72.44	Professional	26	$45.71	$52.48	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $245.47 / $295.12	Professional	TC	$165.96	$245.47	$295.12
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Facility	26	$79.43	$79.43	$79.43
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $223.87 / $354.81	Professional		$208.93	$223.87	$354.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $177.83 / $295.12	Professional	TC	$162.18	$177.83	$295.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $131.83 / $263.03	Professional		$23.99	$131.83	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $281.84	Professional		$114.82	$147.91	$281.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $117.49 / $229.09	Professional	TC	$89.13	$117.49	$229.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $281.84	Professional		$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $199.53 / $234.42	Professional	TC	$199.53	$199.53	$234.42