Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.50 / $56.60 / $56.60	Facility	26	$44.50	$56.60	$56.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.77 / $79.95 / $256.80	Professional		$72.77	$79.95	$256.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.89 / $31.95 / $64.00	Professional	26	$28.89	$31.95	$64.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $46.81 / $64.31	Professional	TC	$42.39	$46.81	$64.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.47 / $99.36 / $102.26	Facility	26	$96.47	$99.36	$102.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.55 / $190.05 / $237.56	Professional		$74.55	$190.05	$237.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $75.23 / $94.05	Professional	26	$30.38	$75.23	$94.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.17 / $114.80 / $143.50	Professional	TC	$44.17	$114.80	$143.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $80.62 / $112.10 / $341.45	Professional		$80.62	$112.10	$341.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $47.70 / $159.94	Professional	26	$33.79	$47.70	$159.94
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.41 / $64.40 / $142.71	Professional	TC	$47.41	$64.40	$142.71
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $99.36 / $149.85 / $149.85	Facility	26	$99.36	$149.85	$149.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $79.54 / $116.66 / $546.16	Professional		$79.54	$116.66	$546.16
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.22 / $44.57 / $210.44	Professional	26	$34.22	$44.57	$210.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $43.75 / $56.70 / $335.78	Professional	TC	$43.75	$56.70	$335.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $99.36 / $102.26 / $183.18	Facility	26	$99.36	$102.26	$183.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.62 / $173.65 / $276.26	Professional		$154.62	$173.65	$276.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $107.80 / $107.80 / $107.80	Professional		$107.80	$107.80	$107.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.50 / $93.33 / $158.04	Professional		$79.50	$93.33	$158.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.22 / $41.08 / $68.87	Professional	26	$34.22	$41.08	$68.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.54 / $55.03 / $91.31	Professional	TC	$43.54	$55.03	$91.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $110.05 / $139.30 / $163.90	Professional		$110.05	$139.30	$163.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.64 / $56.50 / $66.50	Professional	26	$44.64	$56.50	$66.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $65.41 / $82.80 / $97.40	Professional	TC	$65.41	$82.80	$97.40