Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.00 / $39.10 / $72.09	Facility	26	$23.00	$39.10	$72.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.78 / $50.13 / $238.70	Professional		$43.78	$50.13	$238.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.93 / $11.23 / $26.52	Professional	26	$9.93	$11.23	$26.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $37.72 / $78.37	Professional	TC	$33.15	$37.72	$78.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.03 / $39.17 / $40.31	Facility	26	$38.03	$39.17	$40.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.80 / $124.11 / $155.13	Professional		$51.80	$124.11	$155.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $25.60 / $32.65	Professional	26	$12.06	$25.60	$32.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.21 / $97.53 / $123.14	Professional	TC	$38.21	$97.53	$123.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.08 / $71.23 / $143.16	Professional		$46.08	$71.23	$143.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.61 / $17.18 / $36.49	Professional	26	$10.61	$17.18	$36.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.47 / $53.48 / $98.56	Professional	TC	$35.47	$53.48	$98.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $39.17 / $100.00 / $100.00	Facility	26	$39.17	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $47.92 / $78.11 / $345.31	Professional		$47.92	$78.11	$345.31
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $15.74 / $142.00	Professional	26	$12.09	$15.74	$142.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $47.48 / $272.83	Professional	TC	$35.83	$47.48	$272.83
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $39.17 / $40.31 / $63.96	Facility	26	$39.17	$40.31	$63.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $78.00 / $103.15 / $156.51	Professional		$78.00	$103.15	$156.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.37 / $47.34 / $89.05	Professional		$11.37	$47.34	$89.05
United Facility/Professional Professional Modifier Low / Median / High Price $47.92 / $59.90 / $98.90	Professional		$47.92	$59.90	$98.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $15.61 / $25.35	Professional	26	$12.09	$15.61	$25.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.83 / $43.69 / $73.02	Professional	TC	$35.83	$43.69	$73.02
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $71.73 / $90.80 / $106.80	Professional		$71.73	$90.80	$106.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.33 / $19.39 / $22.80	Professional	26	$15.33	$19.39	$22.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $56.41 / $71.40 / $84.00	Professional	TC	$56.41	$71.40	$84.00