Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.18 / $22.18 / $22.18	Facility	26	$22.18	$22.18	$22.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $68.67 / $138.68	Professional		$61.64	$68.67	$138.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $16.30 / $38.09	Professional	26	$14.91	$16.30	$38.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $53.19 / $89.44	Professional	TC	$46.00	$53.19	$89.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.27 / $68.26 / $70.25	Facility	26	$66.27	$68.26	$70.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.80 / $188.50 / $235.62	Professional		$69.80	$188.50	$235.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.00 / $38.79 / $48.48	Professional	26	$17.00	$38.79	$48.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.42 / $149.71 / $187.14	Professional	TC	$50.42	$149.71	$187.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $78.56 / $108.38 / $257.86	Professional		$78.56	$108.38	$257.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.55 / $24.29 / $67.66	Professional	26	$17.55	$24.29	$67.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.69 / $84.09 / $160.90	Professional	TC	$61.69	$84.09	$160.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $68.26 / $77.22 / $77.22	Facility	26	$68.26	$77.22	$77.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $72.98 / $111.66 / $415.80	Professional		$72.98	$111.66	$415.80
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $23.25 / $109.02	Professional	26	$17.85	$23.25	$109.02
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $52.38 / $71.80 / $398.67	Professional	TC	$52.38	$71.80	$398.67
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $68.26 / $70.25 / $96.36	Facility	26	$68.26	$70.25	$96.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $124.39 / $167.93 / $237.31	Professional		$124.39	$167.93	$237.31
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $17.02 / $73.48 / $131.18	Professional		$17.02	$73.48	$131.18
United Facility/Professional Professional Modifier Low / Median / High Price $72.98 / $87.59 / $149.63	Professional		$72.98	$87.59	$149.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.85 / $21.82 / $37.43	Professional	26	$17.85	$21.82	$37.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.38 / $66.17 / $114.38	Professional	TC	$52.38	$66.17	$114.38
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $108.23 / $137.00 / $161.19	Professional		$108.23	$137.00	$161.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.99 / $29.10 / $34.29	Professional	26	$22.99	$29.10	$34.29
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $85.24 / $107.90 / $127.00	Professional	TC	$85.24	$107.90	$127.00