Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $39.81 / $97.72	Facility	26	$27.54	$39.81	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $100.00 / $239.88	Professional		$77.62	$100.00	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $45.71 / $275.42	Professional	26	$19.95	$45.71	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $53.70 / $204.17	Professional	TC	$41.69	$53.70	$204.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $54.95 / $56.23	Facility	26	$53.70	$54.95	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $223.87 / $338.84	Professional		$120.23	$223.87	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $104.71 / $131.83	Professional	26	$33.88	$104.71	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $131.83 / $295.12	Professional	TC	$67.61	$131.83	$295.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $162.18 / $588.84	Professional		$87.10	$162.18	$588.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $56.23 / $177.83	Professional	26	$31.62	$56.23	$177.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $81.28 / $562.34	Professional	TC	$44.67	$81.28	$562.34
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $204.17 / $204.17	Facility	26	$107.15	$204.17	$204.17
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $204.17 / $2,884.03	Professional		$109.65	$204.17	$2,884.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $56.23 / $426.58	Professional	26	$19.50	$56.23	$426.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $112.20 / $2,818.38	Professional	TC	$60.26	$112.20	$2,818.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $245.47 / $489.78	Professional		$181.97	$245.47	$489.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $91.20 / $117.49	Professional	26	$39.81	$91.20	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $446.68	Professional	TC	$97.72	$131.83	$446.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $56.23	Facility	26	$56.23	$56.23	$56.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $204.17 / $489.78	Professional		$165.96	$204.17	$489.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $52.48 / $117.49	Professional	26	$33.88	$52.48	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $131.83 / $446.68	Professional	TC	$117.49	$131.83	$446.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $109.65 / $141.25	Professional		$63.10	$109.65	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $346.74	Professional		$102.33	$138.04	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $52.48 / $93.33	Professional	26	$19.50	$52.48	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $83.18 / $323.59	Professional	TC	$53.70	$83.18	$323.59
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $194.98	Professional		$162.18	$162.18	$194.98
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $77.62 / $91.20	Professional	26	$77.62	$77.62	$91.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $102.33	Professional	TC	$87.10	$87.10	$102.33