Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.35 / $48.96 / $112.96	Facility	26	$26.35	$48.96	$112.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.68 / $94.49 / $460.00	Professional		$81.68	$94.49	$460.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.12 / $27.50 / $116.74	Professional	26	$21.12	$27.50	$116.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.94 / $67.38 / $127.53	Professional	TC	$60.94	$67.38	$127.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.15 / $71.22 / $73.30	Facility	26	$69.15	$71.22	$73.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.40 / $225.73 / $282.16	Professional		$86.40	$225.73	$282.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.40 / $65.16 / $81.45	Professional	26	$26.40	$65.16	$81.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.22 / $160.57 / $200.71	Professional	TC	$61.22	$160.57	$200.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $84.13 / $125.16 / $200.93	Professional		$84.13	$125.16	$200.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $39.92 / $75.00	Professional	26	$26.53	$39.92	$75.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.60 / $87.58 / $124.04	Professional	TC	$57.60	$87.58	$124.04
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $128.65 / $128.65	Facility	26	$71.22	$128.65	$128.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $90.02 / $139.00 / $648.50	Professional		$90.02	$139.00	$648.50
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.34 / $38.17 / $180.32	Professional	26	$26.34	$38.17	$180.32
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.71 / $80.54 / $468.12	Professional	TC	$60.71	$80.54	$468.12
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $71.22 / $73.30 / $157.50	Facility	26	$71.22	$73.30	$157.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $124.00 / $190.30 / $257.36	Professional		$124.00	$190.30	$257.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.51 / $86.15 / $158.12	Professional		$28.51	$86.15	$158.12
United Facility/Professional Professional Modifier Low / Median / High Price $90.02 / $117.22 / $190.28	Professional		$90.02	$117.22	$190.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.55 / $35.17 / $58.97	Professional	26	$25.55	$35.17	$58.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.71 / $79.05 / $160.81	Professional	TC	$60.71	$79.05	$160.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $129.88 / $164.40 / $193.40	Professional		$129.88	$164.40	$193.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $38.32 / $48.50 / $57.10	Professional	26	$38.32	$48.50	$57.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $91.56 / $115.90 / $136.40	Professional	TC	$91.56	$115.90	$136.40