Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.09 / $151.01 / $337.30	Facility		$56.09	$151.01	$337.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.63 / $15.63 / $15.63	Facility	26	$15.63	$15.63	$15.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.17 / $199.36 / $614.64	Facility	TC	$42.17	$199.36	$614.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.43 / $43.85 / $99.19	Professional		$30.43	$43.85	$99.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $15.63 / $54.04	Professional	26	$8.23	$15.63	$54.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.20 / $26.38 / $59.46	Professional	TC	$22.20	$26.38	$59.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.52 / $81.73 / $132.41	Professional		$32.52	$81.73	$132.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.10 / $20.76 / $41.06	Professional	26	$9.10	$20.76	$41.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $59.62 / $96.42	Professional	TC	$23.42	$59.62	$96.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $66.73 / $140.94	Professional		$38.36	$66.73	$140.94
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.27 / $18.75 / $85.27	Professional	26	$11.27	$18.75	$85.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.38 / $43.06 / $84.72	Professional	TC	$15.38	$43.06	$84.72
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.86 / $75.00 / $160.15	Facility		$46.86	$75.00	$160.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $164.16 / $164.16 / $164.16	Facility	TC	$164.16	$164.16	$164.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $74.52 / $360.92	Professional		$38.36	$74.52	$360.92
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.37 / $20.83 / $191.54	Professional	26	$11.37	$20.83	$191.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.99 / $45.14 / $268.14	Professional	TC	$26.99	$45.14	$268.14
Midlands Facility/Professional Facility Modifier Low / Median / High Price $47.69 / $74.52 / $109.00	Facility		$47.69	$74.52	$109.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $56.10 / $56.10 / $56.10	Facility	26	$56.10	$56.10	$56.10
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $109.95 / $109.95 / $109.95	Facility	TC	$109.95	$109.95	$109.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.27 / $75.30 / $118.60	Professional		$49.27	$75.30	$118.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.85 / $38.54 / $71.15	Professional		$10.85	$38.54	$71.15
United Facility/Professional Professional Modifier Low / Median / High Price $38.26 / $39.51 / $93.04	Professional		$38.26	$39.51	$93.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.32 / $11.71 / $26.62	Professional	26	$11.32	$11.71	$26.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.99 / $27.80 / $63.18	Professional	TC	$26.99	$27.80	$63.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $72.59 / $85.40 / $100.50	Professional		$72.59	$85.40	$100.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.70 / $22.00 / $25.90	Professional	26	$18.70	$22.00	$25.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.90 / $63.40 / $74.59	Professional	TC	$53.90	$63.40	$74.59