Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.49 / $24.49 / $89.94	Facility	26	$24.49	$24.49	$89.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.16 / $67.66 / $303.60	Professional		$53.16	$67.66	$303.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $16.71 / $41.97	Professional	26	$12.78	$16.71	$41.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.63 / $50.38 / $129.86	Professional	TC	$40.63	$50.38	$129.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.37 / $57.03 / $58.69	Facility	26	$55.37	$57.03	$58.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.44 / $145.83 / $203.35	Professional		$64.44	$145.83	$203.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.21 / $32.58 / $48.51	Professional	26	$16.21	$32.58	$48.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.99 / $113.25 / $152.62	Professional	TC	$46.99	$113.25	$152.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.99 / $91.29 / $167.64	Professional		$53.99	$91.29	$167.64
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.42 / $23.98 / $48.30	Professional	26	$13.42	$23.98	$48.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.58 / $64.31 / $122.35	Professional	TC	$40.58	$64.31	$122.35
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $57.03 / $126.00 / $126.00	Facility	26	$57.03	$126.00	$126.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.77 / $95.70 / $399.42	Professional		$60.77	$95.70	$399.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $20.69 / $137.04	Professional	26	$15.52	$20.69	$137.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $40.40 / $53.70 / $356.00	Professional	TC	$40.40	$53.70	$356.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $57.03 / $58.69 / $79.98	Facility	26	$57.03	$58.69	$79.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $103.62 / $125.98 / $210.56	Professional		$103.62	$125.98	$210.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.51 / $55.33 / $104.99	Professional		$14.51	$55.33	$104.99
United Facility/Professional Professional Modifier Low / Median / High Price $56.55 / $72.04 / $117.45	Professional		$56.55	$72.04	$117.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $19.42 / $31.97	Professional	26	$14.91	$19.42	$31.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.40 / $52.62 / $82.36	Professional	TC	$40.40	$52.62	$82.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.90 / $106.20 / $124.90	Professional		$83.90	$106.20	$124.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.43 / $24.60 / $28.90	Professional	26	$19.43	$24.60	$28.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $64.45 / $81.59 / $96.10	Professional	TC	$64.45	$81.59	$96.10