Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $38.90 / $87.10	Facility	26	$36.31	$38.90	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $204.17 / $602.56	Professional		$95.50	$204.17	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $85.11 / $257.04	Professional	26	$36.31	$85.11	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $93.33 / $354.81	Professional	TC	$57.54	$93.33	$354.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $131.83 / $138.04	Facility	26	$128.82	$131.83	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $263.03 / $323.59	Professional		$107.15	$263.03	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $95.50 / $120.23	Professional	26	$46.77	$95.50	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $165.96 / $208.93	Professional	TC	$66.07	$165.96	$208.93
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $181.97 / $380.19	Professional		$100.00	$181.97	$380.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $75.86 / $154.88	Professional	26	$38.02	$75.86	$154.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $223.87	Professional	TC	$60.26	$102.33	$223.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $131.83 / $181.97 / $181.97	Facility	26	$131.83	$181.97	$181.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $190.55 / $707.95	Professional		$102.33	$190.55	$707.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $63.10 / $257.04	Professional	26	$41.69	$63.10	$257.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $85.11 / $446.68	Professional	TC	$58.88	$85.11	$446.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $281.84	Professional		$190.55	$229.09	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $114.82	Professional	26	$81.28	$100.00	$114.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $144.54 / $177.83	Professional	TC	$107.15	$144.54	$177.83
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Facility	26	$138.04	$138.04	$138.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $257.04 / $302.00	Professional		$208.93	$257.04	$302.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $93.33 / $109.65	Professional	26	$83.18	$93.33	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $162.18 / $194.98	Professional	TC	$125.89	$162.18	$194.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $87.10 / $190.55	Professional		$42.66	$87.10	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $234.42	Professional		$102.33	$128.82	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $93.33	Professional	26	$40.74	$50.12	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $77.62 / $144.54	Professional	TC	$61.66	$77.62	$144.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $229.09	Professional		$190.55	$190.55	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $83.18	Professional	26	$70.79	$70.79	$83.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $144.54	Professional	TC	$120.23	$120.23	$144.54