Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $64.57 / $141.25	Professional		$47.86	$64.57	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $91.20	Professional	26	$28.18	$35.48	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $23.99 / $36.31	Professional	TC	$19.05	$23.99	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $100.00 / $158.49	Professional		$47.86	$100.00	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $58.88 / $93.33	Professional	26	$27.54	$58.88	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $41.69 / $64.57	Professional	TC	$19.50	$41.69	$64.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $64.57 / $151.36	Professional		$46.77	$64.57	$151.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $93.33	Professional	26	$26.92	$40.74	$93.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.30 / $87.10	Professional	TC	$19.05	$26.30	$87.10
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	26	$85.11	$85.11	$85.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $79.43 / $165.96	Professional		$57.54	$79.43	$165.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $46.77 / $102.33	Professional	26	$34.67	$46.77	$102.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $28.84 / $63.10	Professional	TC	$21.38	$28.84	$63.10
Midlands Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $151.36 / $165.96	Professional		$97.72	$151.36	$165.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $91.20 / $131.83	Professional	26	$63.10	$91.20	$131.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $58.88 / $66.07	Professional	TC	$33.88	$58.88	$66.07
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $61.66 / $128.82	Professional		$28.84	$61.66	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $69.18 / $125.89	Professional		$54.95	$69.18	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $77.62	Professional	26	$33.88	$42.66	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $26.30 / $48.98	Professional	TC	$21.38	$26.30	$48.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $128.82	Professional		$87.10	$117.49	$128.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $67.61 / $74.13	Professional	26	$48.98	$67.61	$74.13
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $50.12 / $54.95	Professional	TC	$37.15	$50.12	$54.95