Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.80 / $22.42 / $76.97	Facility	26	$11.80	$22.42	$76.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.36 / $58.18 / $212.74	Professional		$46.36	$58.18	$212.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.80 / $17.61 / $66.00	Professional	26	$11.80	$17.61	$66.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $40.07 / $103.84	Professional	TC	$34.09	$40.07	$103.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.29 / $49.74 / $51.19	Facility	26	$48.29	$49.74	$51.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.24 / $126.44 / $158.05	Professional		$54.24	$126.44	$158.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.79 / $29.48 / $39.86	Professional	26	$13.79	$29.48	$39.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.44 / $96.96 / $121.20	Professional	TC	$40.44	$96.96	$121.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $47.05 / $77.86 / $150.00	Professional		$47.05	$77.86	$150.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.15 / $20.78 / $42.12	Professional	26	$12.15	$20.78	$42.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.90 / $53.59 / $93.24	Professional	TC	$34.90	$53.59	$93.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $49.74 / $110.00 / $110.00	Facility	26	$49.74	$110.00	$110.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $49.74 / $81.38 / $343.08	Professional		$49.74	$81.38	$343.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $18.23 / $113.92	Professional	26	$14.07	$18.23	$113.92
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.54 / $44.62 / $259.85	Professional	TC	$33.54	$44.62	$259.85
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $49.74 / $51.19 / $71.64	Facility	26	$49.74	$51.19	$71.64
Midlands Facility/Professional Professional Modifier Low / Median / High Price $84.69 / $104.61 / $175.74	Professional		$84.69	$104.61	$175.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.08 / $43.47 / $92.32	Professional		$13.08	$43.47	$92.32
United Facility/Professional Professional Modifier Low / Median / High Price $47.04 / $59.98 / $98.55	Professional		$47.04	$59.98	$98.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $17.21 / $32.34	Professional	26	$13.50	$17.21	$32.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.54 / $40.25 / $68.34	Professional	TC	$33.54	$40.25	$68.34
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $73.08 / $92.50 / $108.80	Professional		$73.08	$92.50	$108.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.62 / $22.30 / $26.20	Professional	26	$17.62	$22.30	$26.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $55.46 / $70.20 / $82.60	Professional	TC	$55.46	$70.20	$82.60