Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $87.10 / $194.98	Professional		$72.44	$87.10	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $45.71 / $102.33	Professional	26	$38.02	$45.71	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $42.66 / $93.33	Professional	TC	$34.67	$42.66	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $186.21 / $234.42	Professional		$112.20	$186.21	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $114.82	Professional	26	$77.62	$95.50	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $93.33 / $117.49	Professional	TC	$52.48	$93.33	$117.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $239.88	Professional		$77.62	$112.20	$239.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $63.10 / $123.03	Professional	26	$40.74	$63.10	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $51.29 / $109.65	Professional	TC	$30.90	$51.29	$109.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Facility	26	$194.98	$194.98	$194.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $173.78 / $562.34	Professional		$93.33	$173.78	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $95.50 / $316.23	Professional	26	$53.70	$95.50	$316.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $77.62 / $316.23	Professional	TC	$33.11	$77.62	$316.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $213.80 / $229.09	Professional		$114.82	$213.80	$229.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $109.65 / $165.96	Professional	26	$77.62	$109.65	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $91.20 / $109.65	Professional	TC	$34.67	$91.20	$109.65
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $169.82 / $218.78	Professional		$154.88	$169.82	$218.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $93.33 / $117.49	Professional	26	$83.18	$93.33	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $75.86 / $75.86	Professional	TC	$52.48	$75.86	$75.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $87.10 / $177.83	Professional		$43.65	$87.10	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $138.04 / $223.87	Professional		$87.10	$138.04	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $77.62 / $125.89	Professional	26	$48.98	$77.62	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $63.10 / $100.00	Professional	TC	$34.67	$63.10	$100.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $204.17	Professional		$173.78	$173.78	$204.17
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $87.10 / $102.33	Professional	26	$87.10	$87.10	$102.33
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $102.33	Professional	TC	$87.10	$87.10	$102.33