Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $72.36 / $90.38 / $90.38	Facility		$72.36	$90.38	$90.38
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.06 / $31.06 / $31.06	Facility	26	$31.06	$31.06	$31.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.57 / $55.91 / $125.05	Professional		$47.57	$55.91	$125.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.35 / $21.03 / $53.69	Professional	26	$16.35	$21.03	$53.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.22 / $37.04 / $90.98	Professional	TC	$31.22	$37.04	$90.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.01 / $104.67 / $185.00	Professional		$40.01	$104.67	$185.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.78 / $41.32 / $72.51	Professional	26	$22.78	$41.32	$72.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.05 / $73.00 / $112.89	Professional	TC	$18.05	$73.00	$112.89
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $47.33 / $108.36 / $166.31	Professional		$47.33	$108.36	$166.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.13 / $36.40 / $96.37	Professional	26	$22.13	$36.40	$96.37
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.93 / $60.10 / $87.04	Professional	TC	$10.93	$60.10	$87.04
Medica Facility/Professional Facility Modifier Low / Median / High Price $68.00 / $96.82 / $202.25	Facility		$68.00	$96.82	$202.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $113.52 / $113.52 / $113.52	Facility	26	$113.52	$113.52	$113.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $58.41 / $104.67 / $407.64	Professional		$58.41	$104.67	$407.64
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.58 / $40.11 / $244.00	Professional	26	$22.58	$40.11	$244.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $58.33 / $268.50	Professional	TC	$35.83	$58.33	$268.50
Midlands Facility/Professional Facility Modifier Low / Median / High Price $73.45 / $122.27 / $143.35	Facility		$73.45	$122.27	$143.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $56.79 / $56.79 / $56.79	Facility	26	$56.79	$56.79	$56.79
Midlands Facility/Professional Professional Modifier Low / Median / High Price $81.26 / $113.00 / $166.65	Professional		$81.26	$113.00	$166.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.94 / $64.08 / $116.79	Professional		$21.94	$64.08	$116.79
United Facility/Professional Professional Modifier Low / Median / High Price $58.40 / $61.77 / $141.66	Professional		$58.40	$61.77	$141.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $23.26 / $52.86	Professional	26	$22.54	$23.26	$52.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $39.70 / $95.93	Professional	TC	$35.83	$39.70	$95.93
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $119.10 / $140.19 / $164.80	Professional		$119.10	$140.19	$164.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $36.90 / $43.40 / $51.00	Professional	26	$36.90	$43.40	$51.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $82.30 / $96.80 / $113.80	Professional	TC	$82.30	$96.80	$113.80