Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.86 / $25.63 / $25.63	Facility	26	$13.86	$25.63	$25.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $66.58 / $308.00	Professional		$56.75	$66.58	$308.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $15.66 / $57.20	Professional	26	$13.49	$15.66	$57.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.20 / $50.05 / $123.81	Professional	TC	$43.20	$50.05	$123.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $62.81 / $64.64	Facility	26	$60.98	$62.81	$64.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.26 / $165.22 / $206.53	Professional		$64.26	$165.22	$206.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.18 / $34.13 / $42.66	Professional	26	$15.18	$34.13	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.47 / $131.09 / $163.87	Professional	TC	$46.47	$131.09	$163.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $69.01 / $95.35 / $121.72	Professional		$69.01	$95.35	$121.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.26 / $20.18 / $65.34	Professional	26	$15.26	$20.18	$65.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.37 / $70.39 / $88.91	Professional	TC	$49.37	$70.39	$88.91
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $62.81 / $70.00 / $70.00	Facility	26	$62.81	$70.00	$70.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $62.71 / $96.00 / $293.25	Professional		$62.71	$96.00	$293.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.77 / $20.51 / $95.54	Professional	26	$15.77	$20.51	$95.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $45.17 / $61.15 / $357.49	Professional	TC	$45.17	$61.15	$357.49
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $62.81 / $64.64 / $83.70	Facility	26	$62.81	$64.64	$83.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $114.45 / $143.88 / $218.24	Professional		$114.45	$143.88	$218.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.17 / $58.56 / $117.88	Professional		$15.17	$58.56	$117.88
United Facility/Professional Professional Modifier Low / Median / High Price $62.71 / $75.25 / $126.69	Professional		$62.71	$75.25	$126.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.75 / $19.82 / $33.03	Professional	26	$15.75	$19.82	$33.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.96 / $58.02 / $95.72	Professional	TC	$46.96	$58.02	$95.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.20 / $120.50 / $141.69	Professional		$95.20	$120.50	$141.69
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $25.70 / $30.20	Professional	26	$20.30	$25.70	$30.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $74.89 / $94.80 / $111.50	Professional	TC	$74.89	$94.80	$111.50