Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.32 / $65.30 / $170.58	Facility	26	$35.32	$65.30	$170.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.04 / $116.98 / $557.14	Professional		$101.04	$116.98	$557.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $36.92 / $169.88	Professional	26	$31.76	$36.92	$169.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.14 / $80.54 / $128.37	Professional	TC	$71.14	$80.54	$128.37
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.83 / $106.94 / $110.06	Facility	26	$103.83	$106.94	$110.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.73 / $283.13 / $353.91	Professional		$106.73	$283.13	$353.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.34 / $86.88 / $108.60	Professional	26	$38.34	$86.88	$108.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.66 / $196.25 / $245.32	Professional	TC	$72.66	$196.25	$245.32
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $105.93 / $157.27 / $439.46	Professional		$105.93	$157.27	$439.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.57 / $54.77 / $95.99	Professional	26	$35.57	$54.77	$95.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.36 / $106.30 / $268.64	Professional	TC	$70.36	$106.30	$268.64
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $106.94 / $172.60 / $172.60	Facility	26	$106.94	$172.60	$172.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $112.60 / $179.00 / $812.81	Professional		$112.60	$179.00	$812.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.49 / $51.39 / $240.49	Professional	26	$37.49	$51.39	$240.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $73.14 / $97.01 / $572.32	Professional	TC	$73.14	$97.01	$572.32
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $106.94 / $110.06 / $211.80	Facility	26	$106.94	$110.06	$211.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $163.00 / $240.12 / $319.43	Professional		$163.00	$240.12	$319.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.27 / $114.66 / $201.53	Professional		$38.27	$114.66	$201.53
United Facility/Professional Professional Modifier Low / Median / High Price $107.76 / $135.12 / $239.84	Professional		$107.76	$135.12	$239.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.49 / $47.35 / $78.92	Professional	26	$37.49	$47.35	$78.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.14 / $87.77 / $156.88	Professional	TC	$73.14	$87.77	$156.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $163.29 / $206.70 / $243.20	Professional		$163.29	$206.70	$243.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $51.43 / $65.09 / $76.59	Professional	26	$51.43	$65.09	$76.59
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $111.86 / $141.60 / $166.60	Professional	TC	$111.86	$141.60	$166.60