Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $64.57 / $107.15	Professional		$46.77	$64.57	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $21.88 / $77.62	Professional	26	$15.14	$21.88	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $42.66 / $61.66	Professional	TC	$28.18	$42.66	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $109.65 / $194.98	Professional		$41.69	$109.65	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $45.71 / $75.86	Professional	26	$20.42	$45.71	$75.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $67.61 / $104.71	Professional	TC	$20.89	$67.61	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $91.20 / $131.83	Professional		$61.66	$91.20	$131.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $40.74 / $61.66	Professional	26	$31.62	$40.74	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $50.12 / $91.20	Professional	TC	$12.88	$50.12	$91.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $117.49 / $467.74	Professional		$54.95	$117.49	$467.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $51.29 / $186.21	Professional	26	$23.99	$51.29	$186.21
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $69.18 / $309.03	Professional	TC	$30.90	$69.18	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $194.98	Professional		$93.33	$134.90	$194.98
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $45.71 / $75.86	Professional	26	$29.51	$45.71	$75.86
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $67.61 / $104.71	Professional	TC	$57.54	$67.61	$104.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $138.04	Professional		$85.11	$125.89	$138.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $51.29	Professional	26	$35.48	$48.98	$51.29
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $74.13 / $89.13	Professional	TC	$48.98	$74.13	$89.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $77.62 / $154.88	Professional		$25.12	$77.62	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $69.18 / $173.78	Professional		$63.10	$69.18	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $26.30 / $70.79	Professional	26	$25.12	$26.30	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $42.66 / $95.50	Professional	TC	$37.15	$42.66	$95.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $199.53	Professional		$144.54	$169.82	$199.53
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $48.98 / $57.54	Professional	26	$41.69	$48.98	$57.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $117.49 / $141.25	Professional	TC	$100.00	$117.49	$141.25