Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.53 / $69.40 / $132.43	Facility	26	$37.53	$69.40	$132.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.75 / $141.01 / $542.08	Professional		$93.75	$141.01	$542.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.53 / $54.71 / $222.12	Professional	26	$36.53	$54.71	$222.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.28 / $66.41 / $239.40	Professional	TC	$57.28	$66.41	$239.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.03 / $132.90 / $136.77	Facility	26	$129.03	$132.90	$136.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.98 / $255.21 / $319.01	Professional		$101.98	$255.21	$319.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.72 / $93.08 / $116.36	Professional	26	$46.72	$93.08	$116.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.51 / $162.12 / $202.65	Professional	TC	$59.51	$162.12	$202.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $95.61 / $148.13 / $289.37	Professional		$95.61	$148.13	$289.37
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.54 / $59.87 / $136.99	Professional	26	$37.54	$59.87	$136.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.17 / $90.19 / $226.46	Professional	TC	$58.17	$90.19	$226.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $132.90 / $181.68 / $181.68	Facility	26	$132.90	$181.68	$181.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $106.57 / $176.00 / $708.49	Professional		$106.57	$176.00	$708.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $54.19 / $257.68	Professional	26	$41.61	$54.19	$257.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $84.59 / $450.80	Professional	TC	$61.71	$84.59	$450.80
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $132.90 / $136.77 / $227.64	Facility	26	$132.90	$136.77	$227.64
Midlands Facility/Professional Professional Modifier Low / Median / High Price $136.40 / $228.61 / $303.26	Professional		$136.40	$228.61	$303.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.90 / $76.27 / $184.32	Professional		$39.90	$76.27	$184.32
United Facility/Professional Professional Modifier Low / Median / High Price $103.68 / $127.88 / $244.90	Professional		$103.68	$127.88	$244.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.61 / $51.98 / $94.63	Professional	26	$41.61	$51.98	$94.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $77.95 / $142.91	Professional	TC	$61.71	$77.95	$142.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $152.22 / $192.70 / $226.70	Professional		$152.22	$192.70	$226.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $56.17 / $71.09 / $83.70	Professional	26	$56.17	$71.09	$83.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $95.99 / $121.50 / $143.00	Professional	TC	$95.99	$121.50	$143.00