Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.32 / $48.37 / $48.37	Facility	26	$26.32	$48.37	$48.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.70 / $105.80 / $200.50	Professional		$90.70	$105.80	$200.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.50 / $27.69 / $105.60	Professional	26	$24.50	$27.69	$105.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.23 / $71.89 / $100.46	Professional	TC	$65.23	$71.89	$100.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.97 / $86.49 / $89.01	Facility	26	$83.97	$86.49	$89.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.95 / $242.64 / $310.27	Professional		$112.95	$242.64	$310.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.95 / $65.16 / $81.45	Professional	26	$32.95	$65.16	$81.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.23 / $176.47 / $228.83	Professional	TC	$80.23	$176.47	$228.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $103.99 / $150.00 / $505.32	Professional		$103.99	$150.00	$505.32
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.95 / $41.75 / $159.61	Professional	26	$28.95	$41.75	$159.61
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.04 / $105.76 / $389.12	Professional	TC	$75.04	$105.76	$389.12
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $86.49 / $128.65 / $128.65	Facility	26	$86.49	$128.65	$128.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.24 / $141.11 / $647.34	Professional		$102.24	$141.11	$647.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.97 / $37.70 / $180.38	Professional	26	$28.97	$37.70	$180.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $71.84 / $93.55 / $494.15	Professional	TC	$71.84	$93.55	$494.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $86.49 / $89.01 / $157.32	Facility	26	$86.49	$89.01	$157.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $195.25 / $225.59 / $395.30	Professional		$195.25	$225.59	$395.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.87 / $105.32 / $185.55	Professional		$28.87	$105.32	$185.55
United Facility/Professional Professional Modifier Low / Median / High Price $100.79 / $130.97 / $251.98	Professional		$100.79	$130.97	$251.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.02 / $37.24 / $70.04	Professional	26	$29.02	$37.24	$70.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.33 / $86.21 / $165.09	Professional	TC	$68.33	$86.21	$165.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $148.44 / $187.90 / $221.10	Professional		$148.44	$187.90	$221.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $39.82 / $50.40 / $59.30	Professional	26	$39.82	$50.40	$59.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $108.63 / $137.50 / $161.80	Professional	TC	$108.63	$137.50	$161.80