Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.08 / $87.84 / $162.34	Facility	26	$36.08	$87.84	$162.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.48 / $108.31 / $483.00	Professional		$73.48	$108.31	$483.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.36 / $29.82 / $66.16	Professional	26	$25.36	$29.82	$66.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.13 / $72.05 / $220.00	Professional	TC	$48.13	$72.05	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.46 / $85.96 / $88.47	Facility	26	$83.46	$85.96	$88.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.52 / $239.69 / $299.61	Professional		$101.52	$239.69	$299.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.19 / $62.83 / $78.54	Professional	26	$29.19	$62.83	$78.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.80 / $176.86 / $221.07	Professional	TC	$73.80	$176.86	$221.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.17 / $132.33 / $185.95	Professional		$89.17	$132.33	$185.95
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $36.71 / $54.10	Professional	26	$25.60	$36.71	$54.10
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.57 / $95.50 / $133.46	Professional	TC	$63.57	$95.50	$133.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $200.24 / $255.84 / $255.84	Facility	26	$200.24	$255.84	$255.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $97.81 / $149.04 / $659.39	Professional		$97.81	$149.04	$659.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.27 / $36.82 / $173.89	Professional	26	$28.27	$36.82	$173.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $68.36 / $91.97 / $485.50	Professional	TC	$68.36	$91.97	$485.50
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $85.96 / $88.47 / $151.80	Facility	26	$85.96	$88.47	$151.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $101.03 / $199.50 / $281.02	Professional		$101.03	$199.50	$281.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.52 / $91.26 / $167.43	Professional		$27.52	$91.26	$167.43
United Facility/Professional Professional Modifier Low / Median / High Price $100.75 / $117.37 / $219.49	Professional		$100.75	$117.37	$219.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.27 / $35.15 / $64.06	Professional	26	$28.27	$35.15	$64.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.54 / $90.43 / $158.55	Professional	TC	$69.54	$90.43	$158.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $155.16 / $196.40 / $231.00	Professional		$155.16	$196.40	$231.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $41.55 / $52.60 / $61.90	Professional	26	$41.55	$52.60	$61.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $113.60 / $143.80 / $169.10	Professional	TC	$113.60	$143.80	$169.10