Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $45.71 / $67.61	Facility	26	$28.84	$45.71	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $181.97 / $645.65	Professional		$91.20	$181.97	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $50.12 / $173.78	Professional	26	$28.84	$50.12	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $436.52	Professional	TC	$61.66	$93.33	$436.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $107.15 / $109.65	Facility	26	$102.33	$107.15	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $251.19 / $316.23	Professional		$114.82	$251.19	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $75.86 / $95.50	Professional	26	$38.02	$75.86	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $173.78 / $218.78	Professional	TC	$77.62	$173.78	$218.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $181.97 / $371.54	Professional		$102.33	$181.97	$371.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $63.10 / $128.82	Professional	26	$30.90	$63.10	$128.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $128.82 / $239.88	Professional	TC	$66.07	$128.82	$239.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $169.82 / $169.82	Facility	26	$107.15	$169.82	$169.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $190.55 / $691.83	Professional		$102.33	$190.55	$691.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $46.77 / $257.04	Professional	26	$32.36	$46.77	$257.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $91.20 / $478.63	Professional	TC	$69.18	$91.20	$478.63
Midlands Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $239.88 / $269.15	Professional		$204.17	$239.88	$269.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $79.43 / $100.00	Professional	26	$64.57	$79.43	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $154.88 / $186.21	Professional	TC	$141.25	$154.88	$186.21
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
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 $64.57 / $83.18 / $104.71	Professional	26	$64.57	$83.18	$104.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $186.21 / $204.17	Professional	TC	$144.54	$186.21	$204.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $75.86 / $177.83	Professional		$33.88	$75.86	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $123.03 / $234.42	Professional		$100.00	$123.03	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $39.81 / $74.13	Professional	26	$32.36	$39.81	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $83.18 / $158.49	Professional	TC	$69.18	$83.18	$158.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $218.78	Professional		$186.21	$186.21	$218.78
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $67.61	Professional	26	$57.54	$57.54	$67.61
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $128.82 / $151.36	Professional	TC	$128.82	$128.82	$151.36