Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.62 / $53.68 / $98.57	Facility	26	$27.62	$53.68	$98.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.99 / $100.65 / $179.45	Professional		$84.99	$100.65	$179.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.71 / $40.97 / $90.72	Professional	26	$16.71	$40.97	$90.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.02 / $54.53 / $161.07	Professional	TC	$44.02	$54.53	$161.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.40 / $55.00 / $56.60	Facility	26	$53.40	$55.00	$56.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.69 / $221.07 / $339.13	Professional		$111.69	$221.07	$339.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.95 / $96.78 / $127.99	Professional	26	$32.95	$96.78	$127.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.86 / $122.65 / $287.62	Professional	TC	$70.86	$122.65	$287.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.53 / $156.41 / $784.60	Professional		$85.53	$156.41	$784.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.57 / $46.33 / $79.75	Professional	26	$31.57	$46.33	$79.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.85 / $75.44 / $753.03	Professional	TC	$42.85	$75.44	$753.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $108.25 / $205.87 / $205.87	Facility	26	$108.25	$205.87	$205.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.28 / $195.24 / $2,899.89	Professional		$111.28	$195.24	$2,899.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $20.18 / $58.74 / $425.60	Professional	26	$20.18	$58.74	$425.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $59.59 / $101.85 / $2,808.09	Professional	TC	$59.59	$101.85	$2,808.09
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $55.00 / $56.60 / $251.88	Facility	26	$55.00	$56.60	$251.88
Midlands Facility/Professional Professional Modifier Low / Median / High Price $164.72 / $204.23 / $742.00	Professional		$164.72	$204.23	$742.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.85 / $67.23 / $137.07	Professional		$40.85	$67.23	$137.07
United Facility/Professional Professional Modifier Low / Median / High Price $101.16 / $131.65 / $244.64	Professional		$101.16	$131.65	$244.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.00 / $54.04 / $90.69	Professional	26	$35.00	$54.04	$90.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.17 / $70.54 / $149.76	Professional	TC	$54.17	$70.54	$149.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $129.47 / $163.90 / $192.80	Professional		$129.47	$163.90	$192.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $61.30 / $77.59 / $91.40	Professional	26	$61.30	$77.59	$91.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $68.09 / $86.20 / $101.40	Professional	TC	$68.09	$86.20	$101.40