Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $91.20 / $95.50	Facility		$69.18	$91.20	$95.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	26	$39.81	$39.81	$39.81
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $54.95 / $54.95 / $69.18	Facility	TC	$54.95	$54.95	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $63.10 / $169.82	Professional		$43.65	$63.10	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $34.67 / $218.78	Professional	26	$19.95	$34.67	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $37.15 / $169.82	Professional	TC	$26.92	$37.15	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $128.82 / $223.87	Professional		$79.43	$128.82	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $60.26 / $123.03	Professional	26	$31.62	$60.26	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $72.44 / $102.33	Professional	TC	$42.66	$72.44	$102.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $107.15 / $269.15	Professional		$87.10	$107.15	$269.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $239.88	Professional	26	$35.48	$48.98	$239.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $63.10 / $239.88	Professional	TC	$51.29	$63.10	$239.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $138.04 / $380.19	Facility		$74.13	$138.04	$380.19
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $234.42 / $234.42 / $234.42	Facility	26	$234.42	$234.42	$234.42
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	TC	$186.21	$186.21	$186.21
Medica Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $128.82 / $645.65	Professional		$63.10	$128.82	$645.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $56.23 / $512.86	Professional	26	$28.18	$56.23	$512.86
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $67.61 / $309.03	Professional	TC	$35.48	$67.61	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $117.49 / $223.87	Professional		$79.43	$117.49	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $51.29 / $123.03	Professional	26	$31.62	$51.29	$123.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $72.44 / $102.33	Professional	TC	$46.77	$72.44	$102.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $128.82 / $151.36	Professional		$125.89	$128.82	$151.36
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $56.23 / $83.18	Professional	26	$53.70	$56.23	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $70.79 / $75.86	Professional	TC	$67.61	$70.79	$75.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $61.66 / $123.03	Professional		$27.54	$61.66	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $69.18 / $169.82	Professional		$63.10	$69.18	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $28.84 / $79.43	Professional	26	$28.18	$28.84	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $39.81 / $95.50	Professional	TC	$35.48	$39.81	$95.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $134.90 / $158.49	Professional		$114.82	$134.90	$158.49
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $53.70 / $63.10	Professional	26	$45.71	$53.70	$63.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $81.28 / $95.50	Professional	TC	$69.18	$81.28	$95.50