Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.37 / $45.37 / $134.63	Facility	26	$45.37	$45.37	$134.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.19 / $114.36 / $217.19	Professional		$97.19	$114.36	$217.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.32 / $25.68 / $42.33	Professional	26	$23.32	$25.68	$42.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.93 / $90.48 / $154.63	Professional	TC	$73.93	$90.48	$154.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.91 / $85.40 / $87.88	Facility	26	$82.91	$85.40	$87.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.21 / $304.85 / $381.06	Professional		$126.21	$304.85	$381.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.41 / $61.28 / $77.98	Professional	26	$28.41	$61.28	$77.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.09 / $243.57 / $304.45	Professional	TC	$95.09	$243.57	$304.45
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.26 / $173.11 / $291.50	Professional		$112.26	$173.11	$291.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.88 / $39.90 / $72.63	Professional	26	$24.88	$39.90	$72.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.38 / $132.06 / $218.87	Professional	TC	$87.38	$132.06	$218.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.40 / $121.12 / $121.12	Facility	26	$85.40	$121.12	$121.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $112.08 / $182.69 / $859.12	Professional		$112.08	$182.69	$859.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.83 / $34.93 / $211.35	Professional	26	$26.83	$34.93	$211.35
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $81.00 / $111.69 / $689.44	Professional	TC	$81.00	$111.69	$689.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $85.40 / $87.88 / $147.54	Facility	26	$85.40	$87.88	$147.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $185.00 / $253.33 / $381.03	Professional		$185.00	$253.33	$381.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.90 / $111.05 / $223.66	Professional		$26.90	$111.05	$223.66
United Facility/Professional Professional Modifier Low / Median / High Price $112.08 / $145.94 / $296.98	Professional		$112.08	$145.94	$296.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.82 / $33.78 / $55.32	Professional	26	$26.82	$33.78	$55.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.26 / $105.72 / $173.83	Professional	TC	$85.26	$105.72	$173.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $174.99 / $221.50 / $260.60	Professional		$174.99	$221.50	$260.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $36.10 / $45.70 / $53.70	Professional	26	$36.10	$45.70	$53.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $138.96 / $175.90 / $206.90	Professional	TC	$138.96	$175.90	$206.90