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 $66.07 / $107.15 / $354.81	Professional		$66.07	$107.15	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $63.10 / $223.87	Professional	26	$38.90	$63.10	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $39.81 / $95.50	Professional	TC	$22.91	$39.81	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $213.80	Professional		$109.65	$169.82	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $89.13 / $112.20	Professional	26	$61.66	$89.13	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $83.18 / $104.71	Professional	TC	$38.90	$83.18	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $251.19	Professional		$72.44	$104.71	$251.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $141.25	Professional	26	$38.02	$56.23	$141.25
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $48.98 / $112.20	Professional	TC	$33.88	$48.98	$112.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $190.55 / $190.55	Facility	26	$95.50	$190.55	$190.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $134.90 / $616.60	Professional		$77.62	$134.90	$616.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $77.62 / $263.03	Professional	26	$46.77	$77.62	$263.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $44.67 / $263.03	Professional	TC	$26.30	$44.67	$263.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $213.80	Professional		$128.82	$173.78	$213.80
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $104.71 / $120.23	Professional	26	$85.11	$104.71	$120.23
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $54.95 / $104.71	Professional	TC	$45.71	$54.95	$104.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $208.93	Professional		$125.89	$125.89	$208.93
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $87.10 / $112.20	Professional	26	$87.10	$87.10	$112.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $38.90 / $100.00	Professional	TC	$38.90	$38.90	$100.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $75.86 / $154.88	Professional		$38.90	$75.86	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $190.55	Professional		$77.62	$112.20	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $72.44 / $120.23	Professional	26	$46.77	$72.44	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $41.69 / $75.86	Professional	TC	$26.30	$41.69	$75.86
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $186.21	Professional		$123.03	$158.49	$186.21
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 $60.26 / $75.86 / $89.13	Professional	TC	$60.26	$75.86	$89.13