Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $234.42	Facility	26	$38.02	$38.02	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $194.98 / $512.86	Professional		$169.82	$194.98	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $154.88 / $407.38	Professional	TC	$131.83	$154.88	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $141.25 / $144.54	Facility	26	$138.04	$141.25	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $616.60	Professional		$489.78	$489.78	$616.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $389.05 / $489.78	Professional	TC	$389.05	$389.05	$489.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $309.03 / $977.24	Professional		$177.83	$309.03	$977.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $72.44 / $158.49	Professional	26	$43.65	$72.44	$158.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $257.04 / $831.76	Professional	TC	$154.88	$257.04	$831.76
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $199.53	Facility	26	$141.25	$141.25	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $426.58 / $870.96	Professional		$218.78	$426.58	$870.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $199.53 / $1,174.90	Professional	TC	$165.96	$199.53	$1,174.90
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $489.78 / $891.25	Professional		$398.11	$489.78	$891.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $100.00 / $165.96	Professional	26	$85.11	$100.00	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $389.05 / $724.44	Professional	TC	$316.23	$389.05	$724.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $144.54 / $144.54	Facility	26	$144.54	$144.54	$144.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $478.63 / $524.81	Professional		$478.63	$478.63	$524.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $380.19 / $416.87	Professional	TC	$380.19	$380.19	$416.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $165.96 / $354.81	Professional		$43.65	$165.96	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $251.19 / $537.03	Professional		$208.93	$251.19	$537.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $199.53 / $426.58	Professional	TC	$165.96	$199.53	$426.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $346.74 / $407.38	Professional		$275.42	$346.74	$407.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $275.42 / $323.59	Professional	TC	$218.78	$275.42	$323.59