Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $35.48 / $52.48	Facility	26	$22.91	$35.48	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $128.82 / $549.54	Professional		$85.11	$128.82	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $35.48 / $107.15	Professional	26	$22.91	$35.48	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $75.86 / $302.00	Professional	TC	$60.26	$75.86	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $104.71 / $107.15	Facility	26	$100.00	$104.71	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $257.04 / $323.59	Professional		$100.00	$257.04	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $58.88 / $74.13	Professional	26	$30.20	$58.88	$74.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $194.98 / $245.47	Professional	TC	$72.44	$194.98	$245.47
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $275.42 / $407.38	Professional		$104.71	$275.42	$407.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $63.10 / $123.03	Professional	26	$26.30	$63.10	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $288.40	Professional	TC	$72.44	$104.71	$288.40
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $117.49 / $117.49	Facility	26	$104.71	$117.49	$117.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $144.54 / $691.83	Professional		$97.72	$144.54	$691.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $34.67 / $165.96	Professional	26	$26.30	$34.67	$165.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $95.50 / $524.81	Professional	TC	$66.07	$95.50	$524.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $229.09 / $275.42	Professional		$173.78	$229.09	$275.42
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $66.07	Professional	26	$52.48	$57.54	$66.07
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $173.78 / $204.17	Professional	TC	$120.23	$173.78	$204.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $251.19 / $295.12	Professional		$208.93	$251.19	$295.12
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $60.26 / $72.44	Professional	26	$57.54	$60.26	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $190.55 / $218.78	Professional	TC	$154.88	$190.55	$218.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $83.18 / $177.83	Professional		$26.92	$83.18	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $123.03 / $234.42	Professional		$97.72	$123.03	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $32.36 / $61.66	Professional	26	$26.92	$32.36	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $91.20 / $173.78	Professional	TC	$69.18	$91.20	$173.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $223.87	Professional		$190.55	$190.55	$223.87
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $45.71 / $53.70	Professional	26	$45.71	$45.71	$53.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $169.82	Professional	TC	$144.54	$144.54	$169.82