Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.94 / $51.90 / $96.05	Facility	26	$27.94	$51.90	$96.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.26 / $125.24 / $605.46	Professional		$88.26	$125.24	$605.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.32 / $41.34 / $161.97	Professional	26	$27.32	$41.34	$161.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.94 / $84.53 / $132.07	Professional	TC	$60.94	$84.53	$132.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.41 / $99.30 / $102.19	Facility	26	$96.41	$99.30	$102.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.97 / $234.26 / $318.95	Professional		$100.97	$234.26	$318.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.02 / $69.04 / $96.02	Professional	26	$35.02	$69.04	$96.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.77 / $165.22 / $207.83	Professional	TC	$68.77	$165.22	$207.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.37 / $139.68 / $328.09	Professional		$89.37	$139.68	$328.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.11 / $45.63 / $104.58	Professional	26	$28.11	$45.63	$104.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.31 / $91.40 / $181.62	Professional	TC	$59.31	$91.40	$181.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $99.30 / $136.22 / $136.22	Facility	26	$99.30	$136.22	$136.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $101.49 / $149.56 / $654.87	Professional		$101.49	$149.56	$654.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.09 / $40.49 / $217.94	Professional	26	$31.09	$40.49	$217.94
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $63.88 / $87.57 / $461.63	Professional	TC	$63.88	$87.57	$461.63
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $99.30 / $102.19 / $167.16	Facility	26	$99.30	$102.19	$167.16
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.94 / $212.78 / $280.50	Professional		$134.94	$212.78	$280.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.42 / $89.37 / $165.74	Professional		$30.42	$89.37	$165.74
United Facility/Professional Professional Modifier Low / Median / High Price $98.34 / $125.77 / $216.37	Professional		$98.34	$125.77	$216.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.09 / $40.22 / $78.29	Professional	26	$31.09	$40.22	$78.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.88 / $87.57 / $147.94	Professional	TC	$63.88	$87.57	$147.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $140.07 / $177.30 / $208.60	Professional		$140.07	$177.30	$208.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.19 / $53.40 / $62.80	Professional	26	$42.19	$53.40	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $97.88 / $123.90 / $145.80	Professional	TC	$97.88	$123.90	$145.80