Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.42 / $29.81 / $91.30	Facility	26	$16.42	$29.81	$91.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.95 / $116.53 / $194.96	Professional		$86.95	$116.53	$194.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.69 / $17.93 / $93.45	Professional	26	$15.69	$17.93	$93.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.26 / $98.85 / $148.97	Professional	TC	$71.26	$98.85	$148.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.87 / $58.58 / $60.28	Facility	26	$56.87	$58.58	$60.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.71 / $227.28 / $299.01	Professional		$100.71	$227.28	$299.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.68 / $39.56 / $143.81	Professional	26	$19.68	$39.56	$143.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.32 / $187.72 / $252.03	Professional	TC	$85.32	$187.72	$252.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $84.12 / $127.02 / $228.56	Professional		$84.12	$127.02	$228.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.88 / $26.43 / $66.00	Professional	26	$16.88	$26.43	$66.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.23 / $103.39 / $138.86	Professional	TC	$67.23	$103.39	$138.86
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $58.58 / $81.76 / $81.76	Facility	26	$58.58	$81.76	$81.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $92.91 / $155.74 / $664.33	Professional		$92.91	$155.74	$664.33
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $18.25 / $23.85 / $113.72	Professional	26	$18.25	$23.85	$113.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $71.19 / $101.70 / $550.61	Professional	TC	$71.19	$101.70	$550.61
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $58.58 / $60.28 / $96.84	Facility	26	$58.58	$60.28	$96.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $140.00 / $191.20 / $329.46	Professional		$140.00	$191.20	$329.46
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $18.73 / $86.27 / $164.43	Professional		$18.73	$86.27	$164.43
United Facility/Professional Professional Modifier Low / Median / High Price $89.29 / $116.27 / $191.53	Professional		$89.29	$116.27	$191.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.17 / $23.57 / $38.83	Professional	26	$18.17	$23.57	$38.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.19 / $90.77 / $153.24	Professional	TC	$71.19	$90.77	$153.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $128.00 / $165.10 / $194.20	Professional		$128.00	$165.10	$194.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $24.17 / $30.60 / $36.00	Professional	26	$24.17	$30.60	$36.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $106.26 / $134.50 / $158.19	Professional	TC	$106.26	$134.50	$158.19