Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $69.18 / $147.91	Facility	26	$64.57	$69.18	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $173.78 / $602.56	Professional		$131.83	$173.78	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $102.33 / $295.12	Professional	26	$57.54	$102.33	$295.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $97.72 / $218.78	Professional	TC	$66.07	$97.72	$218.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $173.78 / $177.83	Facility	26	$169.82	$173.78	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $302.00 / $380.19	Professional		$165.96	$302.00	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $158.49 / $199.53	Professional	26	$72.44	$158.49	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $144.54 / $234.42	Professional	TC	$77.62	$144.54	$234.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $223.87 / $933.25	Professional		$114.82	$223.87	$933.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $120.23 / $331.13	Professional	26	$64.57	$120.23	$331.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $77.62 / $512.86	Professional	TC	$50.12	$77.62	$512.86
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $645.65 / $645.65	Facility	26	$501.19	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $269.15 / $1,412.54	Professional		$151.36	$269.15	$1,412.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $93.33 / $436.52	Professional	26	$58.88	$93.33	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $123.03 / $1,148.15	Professional	TC	$74.13	$123.03	$1,148.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $446.68	Professional		$269.15	$338.84	$446.68
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $169.82 / $173.78	Professional	26	$131.83	$169.82	$173.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $181.97 / $309.03	Professional	TC	$123.03	$181.97	$309.03
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $295.12 / $446.68	Professional		$245.47	$295.12	$446.68
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $162.18 / $190.55	Professional	26	$107.15	$162.18	$190.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $144.54 / $309.03	Professional	TC	$128.82	$144.54	$309.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $114.82 / $229.09	Professional		$54.95	$114.82	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $186.21 / $354.81	Professional		$144.54	$186.21	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $169.82	Professional	26	$58.88	$87.10	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $104.71 / $218.78	Professional	TC	$74.13	$104.71	$218.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $251.19	Professional		$213.80	$213.80	$251.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $117.49 / $138.04	Professional	26	$117.49	$117.49	$138.04
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $97.72 / $114.82	Professional	TC	$97.72	$97.72	$114.82