Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $41.69 / $50.12	Facility	26	$20.89	$41.69	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $91.20 / $338.84	Professional		$40.74	$91.20	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $38.90 / $107.15	Professional	26	$19.05	$38.90	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $44.67 / $107.15	Professional	TC	$19.05	$44.67	$107.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $60.26 / $61.66	Facility	26	$58.88	$60.26	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $120.23 / $158.49	Professional		$67.61	$120.23	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $54.95 / $69.18	Professional	26	$21.38	$54.95	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $64.57 / $89.13	Professional	TC	$37.15	$64.57	$89.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $141.25 / $275.42	Professional		$46.77	$141.25	$275.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $39.81 / $89.13	Professional	26	$22.39	$39.81	$89.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $112.20 / $204.17	Professional	TC	$23.99	$112.20	$204.17
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $114.82 / $114.82	Facility	26	$60.26	$114.82	$114.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $95.50 / $575.44	Professional		$48.98	$95.50	$575.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $31.62 / $234.42	Professional	26	$19.50	$31.62	$234.42
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $54.95 / $398.11	Professional	TC	$22.91	$54.95	$398.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $120.23 / $181.97	Professional		$97.72	$120.23	$181.97
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $72.44	Professional	26	$44.67	$57.54	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $61.66 / $138.04	Professional	TC	$50.12	$61.66	$138.04
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $128.82 / $181.97	Professional		$117.49	$128.82	$181.97
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $63.10	Professional	26	$37.15	$57.54	$63.10
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $64.57 / $138.04	Professional	TC	$61.66	$64.57	$138.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $45.71 / $89.13	Professional		$24.55	$45.71	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $70.79 / $114.82	Professional		$47.86	$70.79	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $28.18 / $53.70	Professional	26	$19.50	$28.18	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $79.43	Professional	TC	$22.91	$34.67	$79.43
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $104.71	Professional		$89.13	$89.13	$104.71
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $41.69 / $48.98	Professional	26	$41.69	$41.69	$48.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	TC	$47.86	$47.86	$56.23