Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.02 / $23.02 / $69.28	Facility	26	$23.02	$23.02	$69.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $44.94 / $213.58	Professional		$39.97	$44.94	$213.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $12.84 / $29.81	Professional	26	$11.69	$12.84	$29.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $31.58 / $65.04	Professional	TC	$27.87	$31.58	$65.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.81 / $43.06 / $44.32	Facility	26	$41.81	$43.06	$44.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.05 / $111.70 / $139.63	Professional		$48.05	$111.70	$139.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.15 / $30.25 / $39.77	Professional	26	$14.15	$30.25	$39.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.90 / $81.27 / $101.81	Professional	TC	$33.90	$81.27	$101.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.70 / $67.22 / $121.81	Professional		$41.70	$67.22	$121.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.47 / $20.12 / $39.00	Professional	26	$12.47	$20.12	$39.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.23 / $45.81 / $78.18	Professional	TC	$29.23	$45.81	$78.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $43.06 / $100.00 / $100.00	Facility	26	$43.06	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $43.47 / $74.19 / $438.00	Professional		$43.47	$74.19	$438.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $18.05 / $97.41	Professional	26	$13.86	$18.05	$97.41
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $29.61 / $39.13 / $423.00	Professional	TC	$29.61	$39.13	$423.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $43.06 / $44.32 / $75.42	Facility	26	$43.06	$44.32	$75.42
Midlands Facility/Professional Professional Modifier Low / Median / High Price $74.66 / $93.75 / $155.21	Professional		$74.66	$93.75	$155.21
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.80 / $63.80 / $123.40	Professional		$63.80	$63.80	$123.40
United Facility/Professional Professional Modifier Low / Median / High Price $43.47 / $54.34 / $87.46	Professional		$43.47	$54.34	$87.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $17.32 / $29.06	Professional	26	$13.86	$17.32	$29.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.61 / $37.01 / $64.97	Professional	TC	$29.61	$37.01	$64.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $64.45 / $81.59 / $96.10	Professional		$64.45	$81.59	$96.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.01 / $22.80 / $26.90	Professional	26	$18.01	$22.80	$26.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $46.45 / $58.80 / $69.20	Professional	TC	$46.45	$58.80	$69.20