Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $25.12 / $162.18	Facility	26	$25.12	$25.12	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $87.10 / $173.78	Professional		$70.79	$87.10	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $57.54 / $97.72	Professional	TC	$46.77	$57.54	$97.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $97.72 / $100.00	Facility	26	$95.50	$97.72	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $208.93 / $263.03	Professional		$120.23	$208.93	$263.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $147.91 / $181.97	Professional	TC	$81.28	$147.91	$181.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $208.93	Professional		$79.43	$125.89	$208.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $42.66 / $66.07	Professional	26	$25.70	$42.66	$66.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $81.28 / $154.88	Professional	TC	$53.70	$81.28	$154.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $123.03 / $123.03	Facility	26	$97.72	$123.03	$123.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $169.82 / $676.08	Professional		$93.33	$169.82	$676.08
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $97.72 / $512.86	Professional	TC	$58.88	$97.72	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $199.53 / $223.87	Professional		$173.78	$199.53	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $64.57 / $81.28	Professional	26	$54.95	$64.57	$81.28
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $138.04 / $154.88	Professional	TC	$117.49	$138.04	$154.88
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $199.53 / $223.87	Professional		$177.83	$199.53	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $138.04 / $154.88	Professional	TC	$114.82	$138.04	$154.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $61.66 / $144.54	Professional		$28.18	$61.66	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $120.23 / $213.80	Professional		$91.20	$120.23	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $81.28 / $141.25	Professional	TC	$61.66	$81.28	$141.25
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $177.83	Professional		$151.36	$151.36	$177.83
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $104.71 / $123.03	Professional	TC	$104.71	$104.71	$123.03