Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.00 / $162.13 / $344.26	Facility		$45.00	$162.13	$344.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.90 / $36.90 / $36.90	Facility	26	$36.90	$36.90	$36.90
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $105.53 / $143.97 / $537.67	Facility	TC	$105.53	$143.97	$537.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $80.56 / $105.68 / $213.15	Professional		$80.56	$105.68	$213.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.43 / $24.94 / $64.66	Professional	26	$19.43	$24.94	$64.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.14 / $72.41 / $161.78	Professional	TC	$61.14	$72.41	$161.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.95 / $172.62 / $268.13	Professional		$60.95	$172.62	$268.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.97 / $49.00 / $74.04	Professional	26	$21.97	$49.00	$74.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.99 / $116.36 / $170.82	Professional	TC	$38.99	$116.36	$170.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $36.04 / $150.02 / $201.10	Professional		$36.04	$150.02	$201.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.26 / $42.19 / $76.34	Professional	26	$26.26	$42.19	$76.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $5.34 / $106.97 / $134.16	Professional	TC	$5.34	$106.97	$134.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $80.56 / $124.88 / $232.95	Facility		$80.56	$124.88	$232.95
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $116.58 / $116.58 / $116.58	Facility	26	$116.58	$116.58	$116.58
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $390.55 / $390.55 / $390.55	Facility	TC	$390.55	$390.55	$390.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $91.58 / $187.18 / $715.47	Professional		$91.58	$187.18	$715.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $43.70 / $162.69	Professional	26	$26.81	$43.70	$162.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.48 / $116.95 / $552.78	Professional	TC	$64.48	$116.95	$552.78
Midlands Facility/Professional Facility Modifier Low / Median / High Price $115.06 / $186.45 / $250.55	Facility		$115.06	$186.45	$250.55
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $69.80 / $69.80 / $69.80	Facility	26	$69.80	$69.80	$69.80
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $180.75 / $180.75 / $180.75	Facility	TC	$180.75	$180.75	$180.75
Midlands Facility/Professional Professional Modifier Low / Median / High Price $118.51 / $181.71 / $251.63	Professional		$118.51	$181.71	$251.63
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.55 / $101.23 / $185.41	Professional		$25.55	$101.23	$185.41
United Facility/Professional Professional Modifier Low / Median / High Price $98.68 / $101.64 / $267.58	Professional		$98.68	$101.64	$267.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.81 / $27.65 / $62.83	Professional	26	$26.81	$27.65	$62.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.84 / $74.00 / $168.18	Professional	TC	$71.84	$74.00	$168.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $190.10 / $223.60 / $263.00	Professional		$190.10	$223.60	$263.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $43.70 / $51.40 / $60.40	Professional	26	$43.70	$51.40	$60.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $146.40 / $172.20 / $202.50	Professional	TC	$146.40	$172.20	$202.50