Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $218.78 / $223.87	Facility		$141.25	$218.78	$223.87
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $50.12 / $50.12	Facility	26	$50.12	$50.12	$50.12
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $91.20 / $281.84 / $812.83	Facility	TC	$91.20	$281.84	$812.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $131.83 / $446.68	Professional		$70.79	$131.83	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $61.66 / $316.23	Professional	26	$25.70	$61.66	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $91.20 / $512.86	Professional	TC	$42.66	$91.20	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $181.97 / $309.03	Professional		$61.66	$181.97	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $64.57 / $114.82	Professional	26	$34.67	$64.57	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $117.49 / $169.82	Professional	TC	$33.88	$117.49	$169.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $151.36 / $295.12	Professional		$97.72	$151.36	$295.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $54.95 / $134.90	Professional	26	$44.67	$54.95	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $97.72 / $169.82	Professional	TC	$26.92	$97.72	$169.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $141.25 / $263.03	Facility		$89.13	$141.25	$263.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	26	$169.82	$169.82	$169.82
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	TC	$354.81	$354.81	$354.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $194.98 / $660.69	Professional		$100.00	$194.98	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $61.66 / $275.42	Professional	26	$35.48	$61.66	$275.42
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $112.20 / $426.58	Professional	TC	$60.26	$112.20	$426.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $194.98 / $331.13	Professional		$131.83	$194.98	$331.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $67.61 / $114.82	Professional	26	$39.81	$67.61	$114.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $213.80	Professional	TC	$91.20	$131.83	$213.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $199.53 / $199.53	Professional		$154.88	$199.53	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $83.18	Professional	26	$60.26	$70.79	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $128.82 / $128.82	Professional	TC	$93.33	$128.82	$128.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $102.33 / $208.93	Professional		$34.67	$102.33	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $107.15 / $263.03	Professional		$100.00	$107.15	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $37.15 / $95.50	Professional	26	$35.48	$37.15	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $69.18 / $154.88	Professional	TC	$63.10	$69.18	$154.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $223.87 / $263.03	Professional		$190.55	$223.87	$263.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $79.43	Professional	26	$57.54	$67.61	$79.43
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $186.21	Professional	TC	$134.90	$158.49	$186.21