Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.69 / $44.67 / $97.72	Facility	26	$41.69	$44.67	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $251.19 / $707.95	Professional		$120.23	$251.19	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $100.00 / $245.47	Professional	26	$41.69	$100.00	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $107.15 / $363.08	Professional	TC	$74.13	$107.15	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $154.88 / $158.49	Facility	26	$147.91	$154.88	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $323.59 / $398.11	Professional		$151.36	$323.59	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $109.65 / $138.04	Professional	26	$53.70	$109.65	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $208.93 / $263.03	Professional	TC	$93.33	$208.93	$263.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $234.42 / $467.74	Professional		$131.83	$234.42	$467.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $93.33 / $213.80	Professional	26	$44.67	$93.33	$213.80
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $147.91 / $251.19	Professional	TC	$77.62	$147.91	$251.19
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $213.80 / $213.80	Facility	26	$154.88	$213.80	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $245.47 / $870.96	Professional		$131.83	$245.47	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $64.57 / $295.12	Professional	26	$46.77	$64.57	$295.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $109.65 / $575.44	Professional	TC	$79.43	$109.65	$575.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $346.74	Professional		$263.03	$316.23	$346.74
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $114.82 / $128.82	Professional	26	$95.50	$114.82	$128.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $223.87	Professional	TC	$169.82	$199.53	$223.87
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $407.38	Professional		$275.42	$316.23	$407.38
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $120.23 / $147.91	Professional	26	$95.50	$120.23	$147.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $204.17 / $281.84	Professional	TC	$177.83	$204.17	$281.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $102.33 / $229.09	Professional		$48.98	$102.33	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $158.49 / $302.00	Professional		$128.82	$158.49	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $107.15	Professional	26	$46.77	$58.88	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $100.00 / $190.55	Professional	TC	$81.28	$100.00	$190.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $281.84	Professional		$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $83.18 / $97.72	Professional	26	$83.18	$83.18	$97.72
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $181.97	Professional	TC	$154.88	$154.88	$181.97