Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $65.20 / $91.70 / $91.80	Facility		$65.20	$91.70	$91.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.36 / $38.36 / $38.36	Facility	26	$38.36	$38.36	$38.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $53.44 / $96.03 / $106.89	Facility	TC	$53.44	$96.03	$106.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.32 / $61.23 / $118.88	Professional		$48.32	$61.23	$118.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.19 / $25.91 / $147.55	Professional	26	$20.19	$25.91	$147.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.13 / $33.40 / $77.11	Professional	TC	$28.13	$33.40	$77.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.25 / $118.19 / $222.79	Professional		$58.25	$118.19	$222.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $53.31 / $124.15	Professional	26	$25.75	$53.31	$124.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.50 / $68.37 / $102.09	Professional	TC	$32.50	$68.37	$102.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $63.64 / $107.15 / $267.74	Professional		$63.64	$107.15	$267.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.27 / $43.98 / $188.02	Professional	26	$27.27	$43.98	$188.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.36 / $63.32 / $130.40	Professional	TC	$36.36	$63.32	$130.40
Medica Facility/Professional Facility Modifier Low / Median / High Price $74.41 / $138.37 / $379.47	Facility		$74.41	$138.37	$379.47
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $234.18 / $234.18 / $234.18	Facility	26	$234.18	$234.18	$234.18
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $186.22 / $186.22 / $186.22	Facility	TC	$186.22	$186.22	$186.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $63.72 / $127.00 / $641.00	Professional		$63.72	$127.00	$641.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.89 / $53.77 / $513.00	Professional	26	$27.89	$53.77	$513.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $58.33 / $312.17	Professional	TC	$35.83	$58.33	$312.17
Midlands Facility/Professional Facility Modifier Low / Median / High Price $78.84 / $118.19 / $199.00	Facility		$78.84	$118.19	$199.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $150.38 / $150.38 / $150.38	Facility	26	$150.38	$150.38	$150.38
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $124.05 / $124.05 / $124.05	Facility	TC	$124.05	$124.05	$124.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $78.84 / $118.19 / $199.00	Professional		$78.84	$118.19	$199.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.65 / $61.69 / $113.61	Professional		$26.65	$61.69	$113.61
United Facility/Professional Professional Modifier Low / Median / High Price $63.71 / $65.63 / $149.16	Professional		$63.71	$65.63	$149.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.86 / $28.73 / $74.68	Professional	26	$27.86	$28.73	$74.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $36.90 / $83.88	Professional	TC	$35.83	$36.90	$83.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $115.20 / $135.50 / $159.40	Professional		$115.20	$135.50	$159.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $45.40 / $53.40 / $62.80	Professional	26	$45.40	$53.40	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $69.80 / $82.10 / $96.60	Professional	TC	$69.80	$82.10	$96.60