Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.57 / $34.33 / $34.33	Facility	26	$18.57	$34.33	$34.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $86.40 / $180.00	Professional		$73.73	$86.40	$180.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.23 / $19.26 / $44.32	Professional	26	$17.23	$19.26	$44.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $67.95 / $129.12	Professional	TC	$55.57	$67.95	$129.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.89 / $79.20 / $81.50	Facility	26	$76.89	$79.20	$81.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.34 / $231.16 / $288.95	Professional		$83.34	$231.16	$288.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.13 / $45.77 / $57.21	Professional	26	$20.13	$45.77	$57.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.23 / $185.39 / $231.74	Professional	TC	$61.23	$185.39	$231.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $96.45 / $130.72 / $273.77	Professional		$96.45	$130.72	$273.77
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.52 / $28.76 / $79.97	Professional	26	$20.52	$28.76	$79.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.02 / $101.21 / $134.07	Professional	TC	$76.02	$101.21	$134.07
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $79.20 / $90.84 / $90.84	Facility	26	$79.20	$90.84	$90.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $86.61 / $132.37 / $380.40	Professional		$86.61	$132.37	$380.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $26.49 / $127.82	Professional	26	$20.34	$26.49	$127.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $62.96 / $86.29 / $509.36	Professional	TC	$62.96	$86.29	$509.36
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $79.20 / $81.50 / $110.58	Facility	26	$79.20	$81.50	$110.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.97 / $198.07 / $283.74	Professional		$147.97	$198.07	$283.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.12 / $90.60 / $161.72	Professional		$20.12	$90.60	$161.72
United Facility/Professional Professional Modifier Low / Median / High Price $86.60 / $108.26 / $190.84	Professional		$86.60	$108.26	$190.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.34 / $24.41 / $40.92	Professional	26	$20.34	$24.41	$40.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.27 / $82.83 / $145.53	Professional	TC	$66.27	$82.83	$145.53
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $133.04 / $168.40 / $198.20	Professional		$133.04	$168.40	$198.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $27.10 / $34.29 / $40.29	Professional	26	$27.10	$34.29	$40.29
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $106.02 / $134.19 / $157.80	Professional	TC	$106.02	$134.19	$157.80