Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $110.69 / $127.95 / $135.69	Facility		$110.69	$127.95	$135.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.62 / $16.62 / $16.62	Facility	26	$16.62	$16.62	$16.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $94.04 / $197.67 / $622.96	Facility	TC	$94.04	$197.67	$622.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.26 / $76.06 / $145.88	Professional		$58.26	$76.06	$145.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.75 / $11.33 / $57.49	Professional	26	$8.75	$11.33	$57.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.50 / $58.66 / $132.57	Professional	TC	$49.50	$58.66	$132.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $123.92 / $193.73	Professional		$40.74	$123.92	$193.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.91 / $22.00 / $36.25	Professional	26	$9.91	$22.00	$36.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.83 / $101.84 / $148.79	Professional	TC	$30.83	$101.84	$148.79
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $107.57 / $146.51	Professional		$20.42	$107.57	$146.51
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.97 / $19.01 / $51.36	Professional	26	$11.97	$19.01	$51.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.45 / $87.36 / $109.88	Professional	TC	$4.45	$87.36	$109.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $58.26 / $90.30 / $166.16	Facility		$58.26	$90.30	$166.16
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 $319.41 / $319.41 / $319.41	Facility	TC	$319.41	$319.41	$319.41
Medica Facility/Professional Professional Modifier Low / Median / High Price $65.76 / $129.88 / $514.55	Professional		$65.76	$129.88	$514.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.72 / $20.21 / $87.52	Professional	26	$11.72	$20.21	$87.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $95.11 / $439.92	Professional	TC	$53.70	$95.11	$439.92
Midlands Facility/Professional Facility Modifier Low / Median / High Price $80.80 / $132.99 / $175.24	Facility		$80.80	$132.99	$175.24
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $31.15 / $31.15 / $31.15	Facility	26	$31.15	$31.15	$31.15
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $144.09 / $144.09 / $144.09	Facility	TC	$144.09	$144.09	$144.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $85.29 / $125.88 / $185.00	Professional		$85.29	$125.88	$185.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.76 / $74.23 / $135.28	Professional		$11.76	$74.23	$135.28
United Facility/Professional Professional Modifier Low / Median / High Price $70.51 / $72.63 / $165.06	Professional		$70.51	$72.63	$165.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.04 / $12.09 / $28.30	Professional	26	$12.04	$12.09	$28.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.42 / $60.17 / $136.76	Professional	TC	$58.42	$60.17	$136.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $139.60 / $164.20 / $193.10	Professional		$139.60	$164.20	$193.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.89 / $23.40 / $27.50	Professional	26	$19.89	$23.40	$27.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $140.80 / $165.60	Professional	TC	$119.70	$140.80	$165.60