Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $85.11 / $213.80	Facility	26	$60.26	$85.11	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $162.18 / $645.65	Professional		$120.23	$162.18	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $48.98 / $190.55	Professional	26	$38.90	$48.98	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $208.93	Professional	TC	$77.62	$107.15	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $295.12 / $426.58	Professional		$186.21	$295.12	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $97.72 / $128.82	Professional	26	$56.23	$97.72	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $204.17 / $288.40	Professional	TC	$125.89	$204.17	$288.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $316.23 / $602.56	Professional		$134.90	$316.23	$602.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $95.50 / $173.78	Professional	26	$42.66	$95.50	$173.78
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $223.87 / $436.52	Professional	TC	$83.18	$223.87	$436.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $269.15 / $1,096.48	Professional		$144.54	$269.15	$1,096.48
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $74.13 / $446.68	Professional	26	$46.77	$74.13	$446.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $173.78 / $870.96	Professional	TC	$97.72	$173.78	$870.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $331.13 / $389.05	Professional		$269.15	$331.13	$389.05
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $109.65 / $128.82	Professional	26	$89.13	$109.65	$128.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $223.87 / $281.84	Professional	TC	$169.82	$223.87	$281.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $331.13 / $389.05	Professional		$218.78	$331.13	$389.05
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $120.23	Professional	26	$85.11	$112.20	$120.23
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $223.87 / $281.84	Professional	TC	$134.90	$223.87	$281.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $128.82 / $275.42	Professional		$44.67	$128.82	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $218.78 / $380.19	Professional		$144.54	$218.78	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $67.61 / $125.89	Professional	26	$45.71	$67.61	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $151.36 / $251.19	Professional	TC	$97.72	$151.36	$251.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $316.23	Professional		$269.15	$269.15	$316.23
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $100.00	Professional	26	$85.11	$85.11	$100.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $186.21 / $218.78	Professional	TC	$186.21	$186.21	$218.78