Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $57.54 / $123.03	Facility	26	$53.70	$57.54	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $275.42 / $616.60	Professional		$169.82	$275.42	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $229.09	Professional	26	$53.70	$81.28	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $416.87	Professional	TC	$112.20	$186.21	$416.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $186.21 / $190.55	Facility	26	$181.97	$186.21	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $416.87 / $562.34	Professional		$245.47	$416.87	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $134.90 / $165.96	Professional	26	$75.86	$134.90	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $316.23 / $407.38	Professional	TC	$190.55	$316.23	$407.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $295.12 / $1,202.26	Professional		$154.88	$295.12	$1,202.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $354.81	Professional	26	$53.70	$95.50	$354.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $194.98 / $933.25	Professional	TC	$102.33	$194.98	$933.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $416.87 / $537.03 / $537.03	Facility	26	$416.87	$537.03	$537.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $363.08 / $1,862.09	Professional		$199.53	$363.08	$1,862.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $89.13 / $436.52	Professional	26	$60.26	$89.13	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $251.19 / $1,905.46	Professional	TC	$134.90	$251.19	$1,905.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $691.83	Professional		$338.84	$478.63	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $131.83 / $177.83	Professional	26	$114.82	$131.83	$177.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $323.59 / $575.44	Professional	TC	$223.87	$323.59	$575.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $446.68 / $691.83	Professional		$407.38	$446.68	$691.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $134.90 / $194.98	Professional	26	$114.82	$134.90	$194.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $316.23 / $575.44	Professional	TC	$269.15	$316.23	$575.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $125.89 / $288.40	Professional		$58.88	$125.89	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $275.42 / $489.78	Professional		$190.55	$275.42	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $74.13 / $151.36	Professional	26	$60.26	$74.13	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $199.53 / $354.81	Professional	TC	$128.82	$199.53	$354.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $389.05	Professional		$331.13	$331.13	$389.05
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $109.65 / $128.82	Professional	26	$109.65	$109.65	$128.82
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $257.04	Professional	TC	$218.78	$218.78	$257.04