Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $35.48 / $93.33	Facility	26	$25.12	$35.48	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $616.60	Professional		$93.33	$134.90	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $47.86 / $181.97	Professional	26	$25.12	$47.86	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $446.68	Professional	TC	$61.66	$91.20	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $89.13 / $91.20	Facility	26	$87.10	$89.13	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $354.81	Professional		$194.98	$281.84	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $89.13	Professional	26	$54.95	$70.79	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $213.80 / $269.15	Professional	TC	$141.25	$213.80	$269.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $199.53 / $288.40	Professional		$128.82	$199.53	$288.40
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $53.70 / $131.83	Professional	26	$33.88	$53.70	$131.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $141.25 / $154.88	Professional	TC	$85.11	$141.25	$154.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $147.91 / $147.91	Facility	26	$89.13	$147.91	$147.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $181.97 / $398.11	Professional		$87.10	$181.97	$398.11
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $34.67 / $213.80	Professional	26	$26.30	$34.67	$213.80
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $95.50 / $660.69	Professional	TC	$61.66	$95.50	$660.69
Midlands Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $223.87 / $363.08	Professional		$151.36	$223.87	$363.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.54 / $104.71	Professional	26	$38.90	$57.54	$104.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $162.18 / $263.03	Professional	TC	$109.65	$162.18	$263.03
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $245.47	Professional		$194.98	$245.47	$245.47
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $70.79	Professional	26	$54.95	$70.79	$70.79
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $177.83 / $177.83	Professional	TC	$141.25	$177.83	$177.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $117.49 / $239.88	Professional		$33.11	$117.49	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $128.82 / $269.15	Professional		$87.10	$128.82	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $34.67 / $75.86	Professional	26	$26.30	$34.67	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $95.50 / $194.98	Professional	TC	$61.66	$95.50	$194.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $257.04 / $302.00	Professional		$218.78	$257.04	$302.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $66.07 / $77.62	Professional	26	$56.23	$66.07	$77.62
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $194.98 / $229.09	Professional	TC	$162.18	$194.98	$229.09