Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $33.88 / $77.62	Facility	26	$32.36	$33.88	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $186.21 / $524.81	Professional		$83.18	$186.21	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $74.13 / $199.53	Professional	26	$32.36	$74.13	$199.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $72.44 / $309.03	Professional	TC	$47.86	$72.44	$309.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $114.82 / $120.23	Facility	26	$112.20	$114.82	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $218.78 / $275.42	Professional		$104.71	$218.78	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $83.18 / $104.71	Professional	26	$40.74	$83.18	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $138.04 / $169.82	Professional	TC	$64.57	$138.04	$169.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $173.78 / $346.74	Professional		$85.11	$173.78	$346.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $74.13 / $169.82	Professional	26	$33.88	$74.13	$169.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $109.65 / $208.93	Professional	TC	$50.12	$109.65	$208.93
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $162.18 / $162.18	Facility	26	$114.82	$162.18	$162.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $165.96 / $602.56	Professional		$91.20	$165.96	$602.56
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $234.42	Professional	26	$35.48	$48.98	$234.42
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $70.79 / $371.54	Professional	TC	$53.70	$70.79	$371.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $213.80 / $245.47	Professional		$181.97	$213.80	$245.47
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $87.10 / $104.71	Professional	26	$72.44	$87.10	$104.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $128.82 / $144.54	Professional	TC	$109.65	$128.82	$144.54
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $120.23 / $120.23	Facility	26	$120.23	$120.23	$120.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $213.80 / $257.04	Professional		$199.53	$213.80	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $83.18 / $97.72	Professional	26	$72.44	$83.18	$97.72
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $131.83 / $158.49	Professional	TC	$123.03	$131.83	$158.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $75.86 / $158.49	Professional		$37.15	$75.86	$158.49
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $107.15 / $204.17	Professional		$91.20	$107.15	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $43.65 / $81.28	Professional	26	$35.48	$43.65	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $64.57 / $123.03	Professional	TC	$53.70	$64.57	$123.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $190.55	Professional		$162.18	$162.18	$190.55
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $63.10 / $74.13	Professional	26	$63.10	$63.10	$74.13
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $100.00 / $117.49	Professional	TC	$100.00	$100.00	$117.49