Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $75.86 / $93.33	Facility	26	$38.02	$75.86	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $120.23 / $549.54	Professional		$51.29	$120.23	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $47.86 / $169.82	Professional	26	$25.12	$47.86	$169.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $213.80 / $213.80 / $724.44	Professional	50	$213.80	$213.80	$724.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $28.84 / $141.25	Professional	TC	$10.00	$28.84	$141.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $93.33 / $97.72	Facility	26	$91.20	$93.33	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $181.97	Professional		$102.33	$128.82	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $100.00 / $125.89	Professional	26	$33.88	$100.00	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $31.62 / $120.23	Professional	TC	$21.38	$31.62	$120.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $147.91 / $363.08	Professional		$50.12	$147.91	$363.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $74.13 / $147.91	Professional	26	$40.74	$74.13	$147.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $9.55 / $40.74 / $239.88	Professional	TC	$9.55	$40.74	$239.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $194.98 / $194.98	Facility	26	$102.33	$194.98	$194.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $125.89 / $562.34	Professional		$81.28	$125.89	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $39.81 / $263.03	Professional	26	$29.51	$39.81	$263.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $83.18 / $426.58	Professional	TC	$44.67	$83.18	$426.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $239.88	Professional		$107.15	$138.04	$239.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $144.54	Professional	26	$66.07	$87.10	$144.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $34.67 / $173.78	Professional	TC	$20.89	$34.67	$173.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $97.72 / $97.72	Facility	26	$97.72	$97.72	$97.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $177.83 / $245.47	Professional		$125.89	$177.83	$245.47
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $81.28 / $107.15	Professional	26	$61.66	$81.28	$107.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $95.50 / $186.21	Professional	TC	$25.12	$95.50	$186.21
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $46.77 / $95.50	Professional		$11.22	$46.77	$95.50
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $190.55	Professional		$77.62	$109.65	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $37.15 / $79.43	Professional	26	$29.51	$37.15	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $69.18 / $120.23	Professional	TC	$42.66	$69.18	$120.23
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $112.20	Professional		$95.50	$95.50	$112.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $75.86 / $89.13	Professional	26	$75.86	$75.86	$89.13
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $19.05 / $22.39	Professional	TC	$19.05	$19.05	$22.39