Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $25.70 / $41.69	Facility	26	$18.20	$25.70	$41.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $354.81	Professional		$74.13	$117.49	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $26.92 / $70.79	Professional	26	$16.98	$26.92	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $74.13 / $199.53	Professional	TC	$54.95	$74.13	$199.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $79.43 / $81.28	Facility	26	$77.62	$79.43	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $234.42 / $295.12	Professional		$95.50	$234.42	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $46.77 / $58.88	Professional	26	$23.99	$46.77	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $190.55 / $234.42	Professional	TC	$70.79	$190.55	$234.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $144.54 / $346.74	Professional		$95.50	$144.54	$346.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $26.92 / $79.43	Professional	26	$18.62	$26.92	$79.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $93.33 / $194.98	Professional	TC	$69.18	$93.33	$194.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $91.20 / $91.20	Facility	26	$79.43	$91.20	$91.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $147.91 / $630.96	Professional		$81.28	$147.91	$630.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $26.30 / $128.82	Professional	26	$20.89	$26.30	$128.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $87.10 / $512.86	Professional	TC	$60.26	$87.10	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $208.93 / $251.19	Professional		$147.91	$208.93	$251.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $48.98 / $50.12	Professional	26	$39.81	$48.98	$50.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $165.96 / $199.53	Professional	TC	$109.65	$165.96	$199.53
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $229.09 / $251.19	Professional		$154.88	$229.09	$251.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $46.77 / $50.12	Professional	26	$41.69	$46.77	$50.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $199.53	Professional	TC	$114.82	$181.97	$199.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $81.28 / $173.78	Professional		$20.42	$81.28	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $107.15 / $204.17	Professional		$81.28	$107.15	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.70 / $46.77	Professional	26	$20.42	$25.70	$46.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $83.18 / $158.49	Professional	TC	$61.66	$83.18	$158.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $199.53	Professional		$169.82	$169.82	$199.53
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $34.67 / $40.74	Professional	26	$34.67	$34.67	$40.74
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $158.49	Professional	TC	$134.90	$134.90	$158.49