Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.00 / $47.00 / $139.56	Facility	26	$47.00	$47.00	$139.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $113.50 / $205.81	Professional		$90.73	$113.50	$205.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $26.87 / $52.10	Professional	26	$24.26	$26.87	$52.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.56 / $88.76 / $133.19	Professional	TC	$70.56	$88.76	$133.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.24 / $88.83 / $91.41	Facility	26	$86.24	$88.83	$91.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.01 / $293.20 / $366.52	Professional		$125.01	$293.20	$366.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.56 / $62.83 / $83.71	Professional	26	$29.56	$62.83	$83.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.88 / $230.38 / $287.98	Professional	TC	$92.88	$230.38	$287.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $108.30 / $168.95 / $292.48	Professional		$108.30	$168.95	$292.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.74 / $40.25 / $72.66	Professional	26	$25.74	$40.25	$72.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.56 / $126.16 / $210.88	Professional	TC	$82.56	$126.16	$210.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $88.83 / $125.66 / $125.66	Facility	26	$88.83	$125.66	$125.66
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.69 / $181.62 / $873.78	Professional		$111.69	$181.62	$873.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $37.04 / $198.13	Professional	26	$28.44	$37.04	$198.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $80.61 / $112.23 / $695.99	Professional	TC	$80.61	$112.23	$695.99
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $88.83 / $91.41 / $154.13	Facility	26	$88.83	$91.41	$154.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $180.00 / $250.42 / $382.27	Professional		$180.00	$250.42	$382.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.33 / $107.96 / $221.88	Professional		$28.33	$107.96	$221.88
United Facility/Professional Professional Modifier Low / Median / High Price $110.87 / $145.80 / $244.08	Professional		$110.87	$145.80	$244.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $36.39 / $65.69	Professional	26	$28.44	$36.39	$65.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.61 / $103.09 / $175.18	Professional	TC	$81.61	$103.09	$175.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $168.67 / $213.50 / $251.20	Professional		$168.67	$213.50	$251.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $37.45 / $47.40 / $55.80	Professional	26	$37.45	$47.40	$55.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $131.22 / $166.10 / $195.50	Professional	TC	$131.22	$166.10	$195.50