Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.58 / $35.58 / $110.50	Facility	26	$35.58	$35.58	$110.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.52 / $63.02 / $83.25	Professional		$55.52	$63.02	$83.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.11 / $19.77 / $28.05	Professional	26	$18.11	$19.77	$28.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $42.18 / $55.19	Professional	TC	$37.11	$42.18	$55.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.45 / $69.48 / $71.51	Facility	26	$67.45	$69.48	$71.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.01 / $152.81 / $191.02	Professional		$68.01	$152.81	$191.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.03 / $47.32 / $59.15	Professional	26	$22.03	$47.32	$59.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.05 / $105.50 / $131.87	Professional	TC	$44.05	$105.50	$131.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $57.39 / $85.28 / $190.55	Professional		$57.39	$85.28	$190.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.36 / $28.26 / $61.07	Professional	26	$19.36	$28.26	$61.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $59.52 / $98.79	Professional	TC	$38.02	$59.52	$98.79
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $69.48 / $94.47 / $94.47	Facility	26	$69.48	$94.47	$94.47
Medica Facility/Professional Professional Modifier Low / Median / High Price $62.26 / $102.45 / $420.07	Professional		$62.26	$102.45	$420.07
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $28.33 / $132.09	Professional	26	$21.75	$28.33	$132.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $39.43 / $49.80 / $288.04	Professional	TC	$39.43	$49.80	$288.04
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $69.48 / $71.51 / $116.46	Facility	26	$69.48	$71.51	$116.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $111.00 / $139.47 / $221.90	Professional		$111.00	$139.47	$221.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.93 / $58.68 / $109.38	Professional		$20.93	$58.68	$109.38
United Facility/Professional Professional Modifier Low / Median / High Price $59.22 / $77.12 / $184.78	Professional		$59.22	$77.12	$184.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $27.19 / $53.13	Professional	26	$21.75	$27.19	$53.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.47 / $48.79 / $82.24	Professional	TC	$37.47	$48.79	$82.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.43 / $120.80 / $142.10	Professional		$95.43	$120.80	$142.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $38.20 / $45.00	Professional	26	$30.18	$38.20	$45.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $65.25 / $82.60 / $97.20	Professional	TC	$65.25	$82.60	$97.20