Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $23.99 / $144.54	Facility	26	$23.99	$23.99	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $117.49 / $275.42	Professional		$85.11	$117.49	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $104.71	Professional	26	$21.88	$28.18	$104.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $154.88	Professional	TC	$70.79	$91.20	$154.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $89.13 / $91.20	Facility	26	$87.10	$89.13	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $302.00 / $371.54	Professional		$131.83	$302.00	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $64.57 / $81.28	Professional	26	$34.67	$64.57	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $234.42 / $295.12	Professional	TC	$97.72	$234.42	$295.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $169.82 / $380.19	Professional		$112.20	$169.82	$380.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $87.10	Professional	26	$25.70	$41.69	$87.10
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $302.00	Professional	TC	$87.10	$125.89	$302.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $125.89 / $125.89	Facility	26	$89.13	$125.89	$125.89
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $870.96	Professional		$109.65	$190.55	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $41.69 / $199.53	Professional	26	$28.18	$41.69	$199.53
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $114.82 / $691.83	Professional	TC	$75.86	$114.82	$691.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $263.03 / $331.13	Professional		$213.80	$263.03	$331.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $64.57 / $83.18	Professional	26	$56.23	$64.57	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $263.03	Professional	TC	$151.36	$194.98	$263.03
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $213.80 / $331.13	Professional		$199.53	$213.80	$331.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $64.57 / $81.28	Professional	26	$56.23	$64.57	$81.28
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $158.49 / $263.03	Professional	TC	$138.04	$158.49	$263.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $107.15 / $229.09	Professional		$29.51	$107.15	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $251.19	Professional		$107.15	$138.04	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $63.10	Professional	26	$28.18	$35.48	$63.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $102.33 / $190.55	Professional	TC	$77.62	$102.33	$190.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $251.19	Professional		$213.80	$213.80	$251.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	26	$47.86	$47.86	$56.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $165.96 / $194.98	Professional	TC	$165.96	$165.96	$194.98