Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.19 / $43.14 / $130.51	Facility	26	$23.19	$43.14	$130.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.73 / $114.04 / $443.92	Professional		$89.73	$114.04	$443.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.71 / $25.05 / $127.00	Professional	26	$22.71	$25.05	$127.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.86 / $87.61 / $130.28	Professional	TC	$67.86	$87.61	$130.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.26 / $81.64 / $84.02	Facility	26	$79.26	$81.64	$84.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.28 / $269.39 / $357.79	Professional		$115.28	$269.39	$357.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.74 / $56.63 / $73.97	Professional	26	$26.74	$56.63	$73.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.77 / $206.36 / $287.01	Professional	TC	$83.77	$206.36	$287.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $105.70 / $153.40 / $311.33	Professional		$105.70	$153.40	$311.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.42 / $38.27 / $88.17	Professional	26	$23.42	$38.27	$88.17
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.16 / $104.83 / $197.08	Professional	TC	$78.16	$104.83	$197.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $81.64 / $113.54 / $113.54	Facility	26	$81.64	$113.54	$113.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $113.62 / $180.62 / $841.81	Professional		$113.62	$180.62	$841.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.12 / $33.83 / $205.77	Professional	26	$26.12	$33.83	$205.77
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $66.26 / $123.70 / $680.78	Professional	TC	$66.26	$123.70	$680.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $81.64 / $84.02 / $140.16	Facility	26	$81.64	$84.02	$140.16
Midlands Facility/Professional Professional Modifier Low / Median / High Price $139.00 / $247.99 / $318.27	Professional		$139.00	$247.99	$318.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.23 / $112.16 / $200.21	Professional		$25.23	$112.16	$200.21
United Facility/Professional Professional Modifier Low / Median / High Price $114.39 / $156.80 / $248.70	Professional		$114.39	$156.80	$248.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $31.18 / $53.56	Professional	26	$25.98	$31.18	$53.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $88.65 / $122.97 / $192.53	Professional	TC	$88.65	$122.97	$192.53
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $164.64 / $208.40 / $245.20	Professional		$164.64	$208.40	$245.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $33.81 / $42.80 / $50.40	Professional	26	$33.81	$42.80	$50.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $130.82 / $165.60 / $194.80	Professional	TC	$130.82	$165.60	$194.80