Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.28 / $25.02 / $81.09	Facility	26	$20.28	$25.02	$81.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.91 / $75.26 / $313.08	Professional		$52.91	$75.26	$313.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.07 / $16.17 / $37.90	Professional	26	$13.07	$16.17	$37.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.34 / $51.21 / $88.01	Professional	TC	$40.34	$51.21	$88.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.80 / $53.35 / $54.91	Facility	26	$51.80	$53.35	$54.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.61 / $143.50 / $179.38	Professional		$70.61	$143.50	$179.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.69 / $33.36 / $48.47	Professional	26	$15.69	$33.36	$48.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.42 / $110.15 / $137.69	Professional	TC	$50.42	$110.15	$137.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.43 / $90.32 / $189.19	Professional		$53.43	$90.32	$189.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.70 / $24.35 / $51.59	Professional	26	$13.70	$24.35	$51.59
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.72 / $62.98 / $137.60	Professional	TC	$39.72	$62.98	$137.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $53.35 / $126.00 / $126.00	Facility	26	$53.35	$126.00	$126.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.27 / $97.00 / $399.42	Professional		$60.27	$97.00	$399.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.52 / $20.69 / $151.90	Professional	26	$15.52	$20.69	$151.90
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $41.88 / $55.64 / $307.58	Professional	TC	$41.88	$55.64	$307.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $53.35 / $54.91 / $79.98	Facility	26	$53.35	$54.91	$79.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $108.09 / $129.11 / $208.32	Professional		$108.09	$129.11	$208.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.72 / $54.74 / $103.37	Professional		$14.72	$54.74	$103.37
United Facility/Professional Professional Modifier Low / Median / High Price $55.32 / $72.04 / $115.60	Professional		$55.32	$72.04	$115.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $19.42 / $52.40	Professional	26	$14.91	$19.42	$52.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.47 / $52.62 / $86.68	Professional	TC	$40.47	$52.62	$86.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.03 / $105.10 / $123.60	Professional		$83.03	$105.10	$123.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $25.10 / $29.60	Professional	26	$19.82	$25.10	$29.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $63.12 / $79.90 / $94.00	Professional	TC	$63.12	$79.90	$94.00