Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $85.11 / $295.12	Facility	26	$56.23	$85.11	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $134.90 / $446.68	Professional		$87.10	$134.90	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $309.03	Professional	26	$54.95	$85.11	$309.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $50.12 / $112.20	Professional	TC	$30.20	$50.12	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $223.87 / $281.84	Professional		$151.36	$223.87	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $131.83 / $173.78	Professional	26	$91.20	$131.83	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $97.72 / $123.03	Professional	TC	$52.48	$97.72	$123.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $141.25 / $331.13	Professional		$95.50	$141.25	$331.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $173.78	Professional	26	$56.23	$72.44	$173.78
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $57.54 / $131.83	Professional	TC	$39.81	$57.54	$131.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $281.84 / $281.84	Facility	26	$141.25	$281.84	$281.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $190.55 / $870.96	Professional		$104.71	$190.55	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $114.82 / $380.19	Professional	26	$69.18	$114.82	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $53.70 / $309.03	Professional	TC	$33.11	$53.70	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $251.19 / $281.84	Professional		$177.83	$251.19	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $158.49 / $199.53	Professional	26	$125.89	$158.49	$199.53
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $72.44 / $123.03	Professional	TC	$52.48	$72.44	$123.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $281.84	Professional		$181.97	$181.97	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $128.82 / $162.18	Professional	26	$128.82	$128.82	$162.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $114.82	Professional	TC	$52.48	$52.48	$114.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $100.00 / $208.93	Professional		$45.71	$100.00	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $154.88 / $257.04	Professional		$104.71	$154.88	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $107.15 / $177.83	Professional	26	$69.18	$107.15	$177.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $52.48 / $89.13	Professional	TC	$33.11	$52.48	$89.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $208.93 / $245.47	Professional		$165.96	$208.93	$245.47
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $141.25	Professional	26	$93.33	$117.49	$141.25
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $89.13 / $104.71	Professional	TC	$70.79	$89.13	$104.71