Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $23.44 / $53.70	Facility	26	$21.88	$23.44	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $446.68	Professional		$91.20	$125.89	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $32.36 / $102.33	Professional	26	$21.88	$32.36	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $95.50 / $234.42	Professional	TC	$67.61	$95.50	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $81.28 / $83.18	Facility	26	$79.43	$81.28	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $295.12 / $363.08	Professional		$117.49	$295.12	$363.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $57.54 / $72.44	Professional	26	$31.62	$57.54	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $234.42 / $295.12	Professional	TC	$93.33	$234.42	$295.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $154.88 / $416.87	Professional		$104.71	$154.88	$416.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $38.90 / $112.20	Professional	26	$23.44	$38.90	$112.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $123.03 / $302.00	Professional	TC	$77.62	$123.03	$302.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $114.82 / $114.82	Facility	26	$81.28	$114.82	$114.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $199.53 / $851.14	Professional		$95.50	$199.53	$851.14
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $38.90 / $204.17	Professional	26	$26.30	$38.90	$204.17
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $128.82 / $676.08	Professional	TC	$61.66	$128.82	$676.08
Midlands Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $257.04 / $316.23	Professional		$162.18	$257.04	$316.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $58.88 / $74.13	Professional	26	$50.12	$58.88	$74.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $204.17 / $257.04	Professional	TC	$112.20	$204.17	$257.04
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	26	$83.18	$83.18	$83.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $245.47 / $316.23	Professional		$181.97	$245.47	$316.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $58.88 / $79.43	Professional	26	$50.12	$58.88	$79.43
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $257.04	Professional	TC	$131.83	$194.98	$257.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $97.72 / $208.93	Professional		$25.70	$97.72	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $147.91 / $251.19	Professional		$91.20	$147.91	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $32.36 / $60.26	Professional	26	$25.70	$32.36	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $117.49 / $199.53	Professional	TC	$66.07	$117.49	$199.53
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $245.47	Professional		$208.93	$208.93	$245.47
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $50.12	Professional	26	$42.66	$42.66	$50.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $165.96 / $194.98	Professional	TC	$165.96	$165.96	$194.98