Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $30.90 / $70.79	Facility	26	$28.84	$30.90	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $467.74	Professional		$91.20	$112.20	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $43.65 / $117.49	Professional	26	$28.18	$43.65	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.13 / $190.55	Professional	TC	$58.88	$74.13	$190.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $100.00 / $102.33	Facility	26	$95.50	$100.00	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $257.04 / $323.59	Professional		$128.82	$257.04	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $77.62 / $95.50	Professional	26	$40.74	$77.62	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $181.97 / $229.09	Professional	TC	$87.10	$181.97	$229.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $158.49 / $512.86	Professional		$107.15	$158.49	$512.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $123.03	Professional	26	$30.90	$44.67	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $95.50 / $389.05	Professional	TC	$67.61	$95.50	$389.05
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $151.36 / $151.36	Facility	26	$100.00	$151.36	$151.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $177.83 / $724.44	Professional		$104.71	$177.83	$724.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $45.71 / $208.93	Professional	26	$33.88	$45.71	$208.93
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $89.13 / $524.81	Professional	TC	$67.61	$89.13	$524.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $239.88 / $281.84	Professional		$194.98	$239.88	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $83.18	Professional	26	$60.26	$75.86	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $162.18 / $199.53	Professional	TC	$134.90	$162.18	$199.53
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $251.19 / $407.38	Professional		$213.80	$251.19	$407.38
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $77.62 / $138.04	Professional	26	$66.07	$77.62	$138.04
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $177.83 / $275.42	Professional	TC	$147.91	$177.83	$275.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $75.86 / $177.83	Professional		$33.11	$75.86	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $128.82 / $239.88	Professional		$104.71	$128.82	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $79.43	Professional	26	$33.88	$42.66	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $87.10 / $158.49	Professional	TC	$67.61	$87.10	$158.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $218.78	Professional		$186.21	$186.21	$218.78
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $66.07	Professional	26	$56.23	$56.23	$66.07
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $128.82 / $151.36	Professional	TC	$128.82	$128.82	$151.36