Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $36.31 / $58.88	Facility	26	$26.92	$36.31	$58.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $144.54 / $501.19	Professional		$74.13	$144.54	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $48.98 / $102.33	Professional	26	$25.70	$48.98	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $89.13 / $338.84	Professional	TC	$47.86	$89.13	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $85.11 / $89.13	Facility	26	$83.18	$85.11	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $245.47 / $309.03	Professional		$123.03	$245.47	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $64.57 / $81.28	Professional	26	$35.48	$64.57	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $181.97 / $223.87	Professional	TC	$81.28	$181.97	$223.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $234.42	Professional		$91.20	$138.04	$234.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $56.23	Professional	26	$25.70	$41.69	$56.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $97.72 / $177.83	Professional	TC	$66.07	$97.72	$177.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $199.53 / $257.04 / $257.04	Facility	26	$199.53	$257.04	$257.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $162.18 / $660.69	Professional		$89.13	$162.18	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $39.81 / $173.78	Professional	26	$28.18	$39.81	$173.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $97.72 / $489.78	Professional	TC	$60.26	$97.72	$489.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $281.84	Professional		$158.49	$199.53	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $67.61 / $79.43	Professional	26	$54.95	$67.61	$79.43
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $144.54 / $204.17	Professional	TC	$79.43	$144.54	$204.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $173.78 / $281.84	Professional		$151.36	$173.78	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $58.88 / $79.43	Professional	26	$53.70	$58.88	$79.43
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $112.20 / $204.17	Professional	TC	$97.72	$112.20	$204.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $75.86 / $169.82	Professional		$27.54	$75.86	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $245.47	Professional		$89.13	$125.89	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $72.44	Professional	26	$28.18	$35.48	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $169.82	Professional	TC	$60.26	$91.20	$169.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $229.09	Professional		$194.98	$194.98	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $61.66	Professional	26	$52.48	$52.48	$61.66
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $169.82	Professional	TC	$144.54	$144.54	$169.82