Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $45.71 / $100.00	Professional		$33.88	$45.71	$100.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.05 / $50.12	Professional	26	$15.14	$19.05	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $23.99 / $39.81	Professional	TC	$19.05	$23.99	$39.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $77.62 / $125.89	Professional		$34.67	$77.62	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $33.88 / $53.70	Professional	26	$15.49	$33.88	$53.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $44.67 / $72.44	Professional	TC	$19.05	$44.67	$72.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $46.77 / $134.90	Professional		$33.88	$46.77	$134.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.99 / $50.12	Professional	26	$15.14	$23.99	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.70 / $87.10	Professional	TC	$18.62	$25.70	$87.10
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $47.86 / $47.86	Facility	26	$47.86	$47.86	$47.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $75.86 / $169.82	Professional		$43.65	$75.86	$169.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $27.54 / $66.07	Professional	26	$19.95	$27.54	$66.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.11 / $112.20	Professional	TC	$23.44	$33.11	$112.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $117.49 / $223.87	Professional		$107.15	$117.49	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $85.11	Professional	26	$39.81	$51.29	$85.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $69.18 / $138.04	Professional	TC	$60.26	$69.18	$138.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $44.67 / $93.33	Professional		$21.38	$44.67	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $53.70 / $95.50	Professional		$42.66	$53.70	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.12 / $44.67	Professional	26	$19.05	$25.12	$44.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $28.18 / $54.95	Professional	TC	$22.39	$28.18	$54.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $87.10 / $93.33	Professional		$63.10	$87.10	$93.33
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $38.02 / $40.74	Professional	26	$27.54	$38.02	$40.74
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $48.98 / $53.70	Professional	TC	$35.48	$48.98	$53.70