Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Facility		$123.03	$123.03	$123.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Facility	26	$40.74	$40.74	$40.74
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $102.33 / $891.25	Facility	TC	$81.28	$102.33	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $234.42 / $891.25	Professional		$70.79	$234.42	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $134.90 / $812.83	Professional	26	$25.70	$134.90	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $77.62 / $275.42	Professional	TC	$37.15	$77.62	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $162.18 / $218.78	Professional		$52.48	$162.18	$218.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $47.86 / $72.44	Professional	26	$16.60	$47.86	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $107.15 / $151.36	Professional	TC	$36.31	$107.15	$151.36
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $151.36 / $263.03	Professional		$74.13	$151.36	$263.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $44.67 / $91.20	Professional	26	$21.88	$44.67	$91.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $91.20 / $190.55	Professional	TC	$52.48	$91.20	$190.55
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $117.49 / $436.52	Facility		$77.62	$117.49	$436.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $316.23 / $316.23 / $316.23	Facility	TC	$316.23	$316.23	$316.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $151.36 / $562.34	Professional		$64.57	$151.36	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $47.86 / $173.78	Professional	26	$28.18	$47.86	$173.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $89.13 / $389.05	Professional	TC	$42.66	$89.13	$389.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $162.18 / $251.19	Professional		$112.20	$162.18	$251.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $47.86 / $85.11	Professional	26	$32.36	$47.86	$85.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $107.15 / $165.96	Professional	TC	$79.43	$107.15	$165.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $173.78	Professional		$134.90	$173.78	$173.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $57.54	Professional	26	$43.65	$57.54	$57.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $117.49 / $117.49	Professional	TC	$91.20	$117.49	$117.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $89.13 / $186.21	Professional		$28.18	$89.13	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $93.33 / $223.87	Professional		$87.10	$93.33	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $29.51 / $70.79	Professional	26	$28.18	$29.51	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $63.10 / $151.36	Professional	TC	$58.88	$63.10	$151.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $194.98 / $229.09	Professional		$162.18	$194.98	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $54.95 / $64.57	Professional	26	$46.77	$54.95	$64.57
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $138.04 / $162.18	Professional	TC	$117.49	$138.04	$162.18