Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.85 / $44.34 / $44.34	Facility	26	$23.85	$44.34	$44.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $101.30 / $530.00	Professional		$86.06	$101.30	$530.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $25.78 / $103.84	Professional	26	$23.34	$25.78	$103.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $71.05 / $139.56	Professional	TC	$61.40	$71.05	$139.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.83 / $103.85 / $106.88	Facility	26	$100.83	$103.85	$106.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $106.59 / $250.55 / $313.19	Professional		$106.59	$250.55	$313.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $58.18 / $72.72	Professional	26	$30.60	$58.18	$72.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.38 / $188.62 / $240.47	Professional	TC	$75.38	$188.62	$240.47
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $105.01 / $159.00 / $410.08	Professional		$105.01	$159.00	$410.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.24 / $39.24 / $123.03	Professional	26	$26.24	$39.24	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.78 / $108.99 / $287.05	Professional	TC	$78.78	$108.99	$287.05
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $103.85 / $116.58 / $116.58	Facility	26	$103.85	$116.58	$116.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.51 / $145.97 / $511.03	Professional		$102.51	$145.97	$511.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.85 / $34.90 / $165.29	Professional	26	$26.85	$34.90	$165.29
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $72.47 / $97.95 / $526.74	Professional	TC	$72.47	$97.95	$526.74
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $103.85 / $106.88 / $144.06	Facility	26	$103.85	$106.88	$144.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.73 / $227.72 / $335.04	Professional		$173.73	$227.72	$335.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.16 / $95.46 / $174.22	Professional		$26.16	$95.46	$174.22
United Facility/Professional Professional Modifier Low / Median / High Price $100.91 / $127.46 / $232.65	Professional		$100.91	$127.46	$232.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.85 / $33.78 / $67.62	Professional	26	$26.85	$33.78	$67.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.40 / $95.24 / $183.58	Professional	TC	$75.40	$95.24	$183.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $149.86 / $189.70 / $223.20	Professional		$149.86	$189.70	$223.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $36.10 / $45.70 / $53.70	Professional	26	$36.10	$45.70	$53.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $113.84 / $144.10 / $169.50	Professional	TC	$113.84	$144.10	$169.50