Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $77.62 / $162.18	Facility	26	$35.48	$77.62	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $239.88 / $954.99	Professional		$131.83	$239.88	$954.99
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $75.86 / $257.04	Professional	26	$35.48	$75.86	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $309.03	Professional	TC	$97.72	$144.54	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $549.54	Professional		$177.83	$346.74	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $87.10 / $151.36	Professional	26	$41.69	$87.10	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $263.03 / $407.38	Professional	TC	$134.90	$263.03	$407.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $346.74 / $616.60	Professional		$151.36	$346.74	$616.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $107.15 / $309.03	Professional	26	$38.02	$107.15	$309.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $229.09 / $416.87	Professional	TC	$109.65	$229.09	$416.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $338.84 / $1,348.96	Professional		$194.98	$338.84	$1,348.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $89.13 / $338.84	Professional	26	$44.67	$89.13	$338.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $1,023.29	Professional	TC	$131.83	$223.87	$1,023.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $398.11 / $426.58	Professional		$288.40	$398.11	$426.58
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $117.49	Professional	26	$77.62	$95.50	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $269.15 / $316.23	Professional	TC	$208.93	$269.15	$316.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $389.05 / $426.58	Professional		$165.96	$389.05	$426.58
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $102.33 / $114.82	Professional	26	$95.50	$102.33	$114.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $295.12 / $316.23	Professional	TC	$269.15	$295.12	$316.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $144.54 / $309.03	Professional		$39.81	$144.54	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $281.84 / $457.09	Professional		$165.96	$281.84	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $77.62 / $117.49	Professional	26	$40.74	$77.62	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $204.17 / $331.13	Professional	TC	$125.89	$204.17	$331.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $346.74	Professional		$288.40	$288.40	$346.74
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $81.28	Professional	26	$69.18	$69.18	$81.28
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $263.03	Professional	TC	$223.87	$223.87	$263.03