Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $50.12 / $107.15	Facility	26	$23.99	$50.12	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $537.03	Professional		$93.33	$177.83	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $37.15 / $154.88	Professional	26	$22.91	$37.15	$154.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $87.10 / $213.80	Professional	TC	$67.61	$87.10	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $213.80 / $295.12	Professional		$128.82	$213.80	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $56.23 / $77.62	Professional	26	$33.11	$56.23	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $158.49 / $218.78	Professional	TC	$100.00	$158.49	$218.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $181.97 / $371.54	Professional		$95.50	$181.97	$371.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $56.23 / $107.15	Professional	26	$24.55	$56.23	$107.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $117.49 / $288.40	Professional	TC	$64.57	$117.49	$288.40
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Facility	26	$134.90	$134.90	$134.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $190.55 / $691.83	Professional		$102.33	$190.55	$691.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $42.66 / $281.84	Professional	26	$26.30	$42.66	$281.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $120.23 / $478.63	Professional	TC	$74.13	$120.23	$478.63
Midlands Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $245.47 / $295.12	Professional		$186.21	$245.47	$295.12
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $63.10 / $77.62	Professional	26	$51.29	$63.10	$77.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $177.83 / $218.78	Professional	TC	$134.90	$177.83	$218.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $275.42	Professional		$190.55	$251.19	$275.42
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $63.10 / $67.61	Professional	26	$47.86	$63.10	$67.61
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $186.21 / $204.17	Professional	TC	$144.54	$186.21	$204.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $95.50 / $199.53	Professional		$25.70	$95.50	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $144.54 / $263.03	Professional		$100.00	$144.54	$263.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $38.90 / $72.44	Professional	26	$26.30	$38.90	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $104.71 / $190.55	Professional	TC	$74.13	$104.71	$190.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $229.09	Professional		$194.98	$194.98	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $57.54	Professional	26	$48.98	$48.98	$57.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $144.54 / $173.78	Professional	TC	$144.54	$144.54	$173.78