Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.30 / $25.63 / $25.63	Facility	26	$20.30	$25.63	$25.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $59.21 / $286.00	Professional		$51.49	$59.21	$286.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.38 / $15.01 / $35.88	Professional	26	$13.38	$15.01	$35.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $42.80 / $86.14	Professional	TC	$37.11	$42.80	$86.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.08 / $66.00 / $67.92	Facility	26	$64.08	$66.00	$67.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.50 / $145.83 / $182.29	Professional		$58.50	$145.83	$182.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.18 / $34.13 / $42.66	Professional	26	$15.18	$34.13	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.71 / $111.70 / $139.63	Professional	TC	$40.71	$111.70	$139.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $60.90 / $84.32 / $215.96	Professional		$60.90	$84.32	$215.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $21.69 / $65.44	Professional	26	$15.31	$21.69	$65.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.10 / $62.63 / $116.73	Professional	TC	$46.10	$62.63	$116.73
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $66.00 / $70.00 / $70.00	Facility	26	$66.00	$70.00	$70.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $55.96 / $83.87 / $266.45	Professional		$55.96	$83.87	$266.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.60 / $20.30 / $93.99	Professional	26	$15.60	$20.30	$93.99
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $39.43 / $51.35 / $301.02	Professional	TC	$39.43	$51.35	$301.02
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $66.00 / $67.92 / $83.70	Facility	26	$66.00	$67.92	$83.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.18 / $129.81 / $198.57	Professional		$104.18	$129.81	$198.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.05 / $48.27 / $101.55	Professional		$15.05	$48.27	$101.55
United Facility/Professional Professional Modifier Low / Median / High Price $55.03 / $66.04 / $115.66	Professional		$55.03	$66.04	$115.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.60 / $19.82 / $33.04	Professional	26	$15.60	$19.82	$33.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.43 / $49.29 / $86.54	Professional	TC	$39.43	$49.29	$86.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.90 / $106.20 / $124.90	Professional		$83.90	$106.20	$124.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.30 / $25.70 / $30.20	Professional	26	$20.30	$25.70	$30.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $63.60 / $80.50 / $94.70	Professional	TC	$63.60	$80.50	$94.70