Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $58.88 / $75.86	Facility	26	$38.02	$58.88	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $74.13 / $302.00	Professional		$57.54	$74.13	$302.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $45.71 / $138.04	Professional	26	$25.70	$45.71	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $37.15 / $85.11	Professional	TC	$28.84	$37.15	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $138.04 / $169.82	Professional		$64.57	$138.04	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $57.54 / $72.44	Professional	26	$28.84	$57.54	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $79.43 / $97.72	Professional	TC	$33.88	$79.43	$97.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $95.50 / $309.03	Professional		$60.26	$95.50	$309.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $43.65 / $120.23	Professional	26	$26.30	$43.65	$120.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $47.86 / $181.97	Professional	TC	$31.62	$47.86	$181.97
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $123.03 / $123.03	Facility	26	$64.57	$123.03	$123.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $117.49 / $724.44	Professional		$61.66	$117.49	$724.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $51.29 / $331.13	Professional	26	$29.51	$51.29	$331.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $51.29 / $562.34	Professional	TC	$30.90	$51.29	$562.34
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $138.04 / $162.18	Professional		$72.44	$138.04	$162.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $66.07 / $72.44	Professional	26	$57.54	$66.07	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $89.13	Professional	TC	$53.70	$72.44	$89.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $117.49 / $229.09	Professional		$112.20	$117.49	$229.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $52.48 / $70.79	Professional	26	$46.77	$52.48	$70.79
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $181.97	Professional	TC	$58.88	$58.88	$181.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $67.61 / $141.25	Professional		$30.20	$67.61	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $89.13 / $151.36	Professional		$60.26	$89.13	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $44.67 / $75.86	Professional	26	$28.18	$44.67	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $75.86	Professional	TC	$30.90	$44.67	$75.86
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $120.23 / $141.25	Professional		$95.50	$120.23	$141.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $60.26	Professional	26	$40.74	$51.29	$60.26
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $81.28	Professional	TC	$53.70	$69.18	$81.28