Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $52.48 / $151.36	Professional		$38.90	$52.48	$151.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $58.88 / $181.97	Professional	26	$26.92	$58.88	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $18.20 / $33.11	Professional	TC	$12.02	$18.20	$33.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $97.72 / $141.25	Professional		$37.15	$97.72	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $60.26 / $91.20	Professional	26	$24.55	$60.26	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $37.15 / $52.48	Professional	TC	$12.88	$37.15	$52.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $85.11 / $144.54	Professional		$60.26	$85.11	$144.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $56.23 / $186.21	Professional	26	$43.65	$56.23	$186.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.75 / $28.84 / $186.21	Professional	TC	$5.75	$28.84	$186.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $154.88	Facility	26	$154.88	$154.88	$154.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $100.00 / $478.63	Professional		$52.48	$100.00	$478.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $72.44 / $346.74	Professional	26	$34.67	$72.44	$346.74
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $34.67 / $331.13	Professional	TC	$17.38	$34.67	$331.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $97.72 / $141.25	Professional		$66.07	$97.72	$141.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $60.26 / $89.13	Professional	26	$40.74	$60.26	$89.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.02 / $52.48	Professional	TC	$25.12	$38.02	$52.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $107.15 / $107.15	Professional		$77.62	$107.15	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $72.44	Professional	26	$48.98	$69.18	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $35.48 / $38.02	Professional	TC	$28.18	$35.48	$38.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $51.29 / $102.33	Professional		$21.38	$51.29	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $57.54 / $147.91	Professional		$53.70	$57.54	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $37.15 / $97.72	Professional	26	$36.31	$37.15	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $19.05 / $46.77	Professional	TC	$17.38	$19.05	$46.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $131.83	Professional		$95.50	$112.20	$131.83
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $69.18 / $81.28	Professional	26	$58.88	$69.18	$81.28
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $43.65 / $51.29	Professional	TC	$37.15	$43.65	$51.29