Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $70.79 / $204.17	Facility	26	$57.54	$70.79	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $102.33 / $323.59	Professional		$70.79	$102.33	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $229.09	Professional	26	$38.02	$57.54	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $43.65 / $107.15	Professional	TC	$23.99	$43.65	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $177.83 / $223.87	Professional		$114.82	$177.83	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $114.82	Professional	26	$61.66	$93.33	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $91.20 / $114.82	Professional	TC	$44.67	$91.20	$114.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $251.19	Professional		$75.86	$109.65	$251.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $134.90	Professional	26	$38.02	$56.23	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $53.70 / $117.49	Professional	TC	$37.15	$53.70	$117.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $204.17 / $204.17	Facility	26	$95.50	$204.17	$204.17
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $144.54 / $676.08	Professional		$81.28	$144.54	$676.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $83.18 / $269.15	Professional	26	$46.77	$83.18	$269.15
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $48.98 / $288.40	Professional	TC	$28.84	$48.98	$288.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $223.87	Professional		$134.90	$190.55	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $107.15 / $125.89	Professional	26	$85.11	$107.15	$125.89
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $61.66 / $114.82	Professional	TC	$48.98	$61.66	$114.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $223.87	Professional		$138.04	$138.04	$223.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $112.20	Professional	26	$93.33	$93.33	$112.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $109.65	Professional	TC	$44.67	$44.67	$109.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $81.28 / $165.96	Professional		$40.74	$81.28	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $117.49 / $199.53	Professional		$81.28	$117.49	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $75.86 / $125.89	Professional	26	$46.77	$75.86	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $47.86 / $83.18	Professional	TC	$29.51	$47.86	$83.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $165.96 / $194.98	Professional		$128.82	$165.96	$194.98
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $95.50	Professional	26	$63.10	$81.28	$95.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $100.00	Professional	TC	$66.07	$83.18	$100.00