Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $46.77 / $72.44	Facility	26	$32.36	$46.77	$72.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $112.20 / $467.74	Professional		$69.18	$112.20	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $36.31 / $218.78	Professional	26	$28.84	$36.31	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $67.61 / $128.82	Professional	TC	$37.15	$67.61	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $275.42	Professional		$138.04	$218.78	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $72.44 / $89.13	Professional	26	$60.26	$72.44	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $147.91 / $186.21	Professional	TC	$63.10	$147.91	$186.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $338.84	Professional		$81.28	$123.03	$338.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $50.12 / $144.54	Professional	26	$33.11	$50.12	$144.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $75.86 / $239.88	Professional	TC	$29.51	$75.86	$239.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Facility	26	$151.36	$151.36	$151.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $165.96 / $691.83	Professional		$77.62	$165.96	$691.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $72.44 / $223.87	Professional	26	$39.81	$72.44	$223.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $95.50 / $467.74	Professional	TC	$27.54	$95.50	$467.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $173.78 / $281.84	Professional		$97.72	$173.78	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $77.62 / $89.13	Professional	26	$66.07	$77.62	$89.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $97.72 / $190.55	Professional	TC	$32.36	$97.72	$190.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $162.18 / $218.78	Professional		$128.82	$162.18	$218.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $70.79 / $89.13	Professional	26	$60.26	$70.79	$89.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $128.82	Professional	TC	$67.61	$91.20	$128.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $100.00 / $208.93	Professional		$35.48	$100.00	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $151.36 / $239.88	Professional		$77.62	$151.36	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $60.26 / $95.50	Professional	26	$37.15	$60.26	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $87.10 / $147.91	Professional	TC	$29.51	$87.10	$147.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $239.88	Professional		$204.17	$204.17	$239.88
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $67.61 / $79.43	Professional	26	$67.61	$67.61	$79.43
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $158.49	Professional	TC	$134.90	$134.90	$158.49