Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.77 / $109.79 / $203.91	Facility	26	$48.77	$109.79	$203.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.65 / $75.31 / $121.37	Professional		$65.65	$75.31	$121.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.21 / $30.67 / $51.26	Professional	26	$27.21	$30.67	$51.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.85 / $44.37 / $63.16	Professional	TC	$36.85	$44.37	$63.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.29 / $108.45 / $111.61	Facility	26	$105.29	$108.45	$111.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.59 / $174.53 / $232.24	Professional		$101.59	$174.53	$232.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.67 / $74.47 / $97.84	Professional	26	$37.67	$74.47	$97.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.62 / $100.63 / $143.81	Professional	TC	$60.62	$100.63	$143.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $67.25 / $112.58 / $221.92	Professional		$67.25	$112.58	$221.92
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.89 / $47.67 / $81.40	Professional	26	$29.89	$47.67	$81.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.04 / $67.62 / $140.52	Professional	TC	$36.04	$67.62	$140.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $108.45 / $145.31 / $145.31	Facility	26	$108.45	$145.31	$145.31
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.16 / $147.84 / $583.91	Professional		$89.16	$147.84	$583.91
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.65 / $46.14 / $335.18	Professional	26	$33.65	$46.14	$335.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $52.59 / $76.06 / $353.01	Professional	TC	$52.59	$76.06	$353.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $108.45 / $111.61 / $179.76	Facility	26	$108.45	$111.61	$179.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.71 / $176.10 / $252.46	Professional		$141.71	$176.10	$252.46
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $98.80 / $98.80 / $253.70	Professional		$98.80	$98.80	$253.70
United Facility/Professional Professional Modifier Low / Median / High Price $89.16 / $112.62 / $216.84	Professional		$89.16	$112.62	$216.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.65 / $42.52 / $77.84	Professional	26	$33.65	$42.52	$77.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.62 / $67.18 / $126.17	Professional	TC	$49.62	$67.18	$126.17
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.44 / $132.19 / $155.50	Professional		$104.44	$132.19	$155.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.95 / $56.90 / $67.00	Professional	26	$44.95	$56.90	$67.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $59.49 / $75.30 / $88.60	Professional	TC	$59.49	$75.30	$88.60