Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.03 / $18.03 / $18.03	Facility	26	$18.03	$18.03	$18.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $55.07 / $109.49	Professional		$46.93	$55.07	$109.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $13.40 / $39.97	Professional	26	$11.40	$13.40	$39.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $39.72 / $84.90	Professional	TC	$34.14	$39.72	$84.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.14 / $58.85 / $60.57	Facility	26	$57.14	$58.85	$60.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.31 / $142.72 / $178.41	Professional		$53.31	$142.72	$178.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.52 / $30.25 / $37.82	Professional	26	$13.52	$30.25	$37.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.47 / $112.48 / $140.60	Professional	TC	$37.47	$112.48	$140.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $59.48 / $82.42 / $177.33	Professional		$59.48	$82.42	$177.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.51 / $19.30 / $55.36	Professional	26	$13.51	$19.30	$55.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $63.06 / $119.20	Professional	TC	$46.43	$63.06	$119.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $58.85 / $70.00 / $70.00	Facility	26	$58.85	$70.00	$70.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $51.95 / $79.31 / $242.97	Professional		$51.95	$79.31	$242.97
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $17.57 / $83.23	Professional	26	$13.50	$17.57	$83.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $36.52 / $50.07 / $296.70	Professional	TC	$36.52	$50.07	$296.70
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $58.85 / $60.57 / $73.44	Facility	26	$58.85	$60.57	$73.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $94.88 / $118.57 / $180.77	Professional		$94.88	$118.57	$180.77
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.53 / $51.02 / $102.96	Professional		$13.53	$51.02	$102.96
United Facility/Professional Professional Modifier Low / Median / High Price $51.95 / $62.92 / $104.52	Professional		$51.95	$62.92	$104.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $16.88 / $28.62	Professional	26	$13.50	$16.88	$28.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.45 / $46.14 / $85.42	Professional	TC	$38.45	$46.14	$85.42
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $82.08 / $103.90 / $122.20	Professional		$82.08	$103.90	$122.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.01 / $22.80 / $26.90	Professional	26	$18.01	$22.80	$26.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $64.06 / $81.09 / $95.40	Professional	TC	$64.06	$81.09	$95.40