Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $67.61 / $91.20	Facility	26	$38.02	$67.61	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $147.91 / $616.60	Professional		$109.65	$147.91	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $58.88 / $151.36	Professional	26	$34.67	$58.88	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $95.50 / $239.88	Professional	TC	$75.86	$95.50	$239.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $107.15 / $109.65	Facility	26	$104.71	$107.15	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $331.13 / $407.38	Professional		$162.18	$331.13	$407.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $97.72 / $123.03	Professional	26	$42.66	$97.72	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $229.09 / $288.40	Professional	TC	$112.20	$229.09	$288.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $416.87	Professional		$123.03	$177.83	$416.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $134.90	Professional	26	$39.81	$60.26	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $123.03 / $309.03	Professional	TC	$83.18	$123.03	$309.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $190.55 / $190.55	Facility	26	$107.15	$190.55	$190.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $223.87 / $933.25	Professional		$123.03	$223.87	$933.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $269.15	Professional	26	$37.15	$57.54	$269.15
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $128.82 / $660.69	Professional	TC	$81.28	$128.82	$660.69
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $288.40 / $354.81	Professional		$213.80	$288.40	$354.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $89.13 / $107.15	Professional	26	$66.07	$89.13	$107.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $199.53 / $251.19	Professional	TC	$147.91	$199.53	$251.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Midlands Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $257.04 / $354.81	Professional		$245.47	$257.04	$354.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $104.71	Professional	26	$66.07	$97.72	$104.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $194.98 / $251.19	Professional	TC	$173.78	$194.98	$251.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $95.50 / $229.09	Professional		$43.65	$95.50	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $162.18 / $302.00	Professional		$123.03	$162.18	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $52.48 / $95.50	Professional	26	$37.15	$52.48	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $109.65 / $199.53	Professional	TC	$81.28	$109.65	$199.53
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $275.42	Professional		$234.42	$234.42	$275.42
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $72.44 / $85.11	Professional	26	$72.44	$72.44	$85.11
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $190.55	Professional	TC	$162.18	$162.18	$190.55