Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.87 / $44.87 / $132.32	Facility	26	$44.87	$44.87	$132.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.43 / $95.78 / $224.13	Professional		$84.43	$95.78	$224.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.03 / $25.57 / $62.00	Professional	26	$23.03	$25.57	$62.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $70.18 / $137.19	Professional	TC	$61.40	$70.18	$137.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.03 / $83.46 / $85.89	Facility	26	$81.03	$83.46	$85.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.83 / $232.71 / $290.89	Professional		$99.83	$232.71	$290.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.78 / $59.73 / $74.66	Professional	26	$27.78	$59.73	$74.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.05 / $172.98 / $216.23	Professional	TC	$72.05	$172.98	$216.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $86.50 / $129.43 / $299.24	Professional		$86.50	$129.43	$299.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.35 / $35.00 / $77.76	Professional	26	$24.35	$35.00	$77.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.15 / $94.29 / $187.75	Professional	TC	$62.15	$94.29	$187.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $83.46 / $118.08 / $118.08	Facility	26	$83.46	$118.08	$118.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $91.88 / $153.13 / $642.13	Professional		$91.88	$153.13	$642.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.18 / $35.40 / $167.46	Professional	26	$27.18	$35.40	$167.46
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.69 / $81.84 / $474.67	Professional	TC	$61.69	$81.84	$474.67
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $83.46 / $85.89 / $145.86	Facility	26	$83.46	$85.89	$145.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $151.00 / $196.05 / $307.89	Professional		$151.00	$196.05	$307.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.20 / $89.94 / $164.24	Professional		$26.20	$89.94	$164.24
United Facility/Professional Professional Modifier Low / Median / High Price $88.87 / $113.32 / $186.48	Professional		$88.87	$113.32	$186.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.18 / $34.21 / $55.57	Professional	26	$27.18	$34.21	$55.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.69 / $77.25 / $125.76	Professional	TC	$61.69	$77.25	$125.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $144.57 / $183.00 / $215.30	Professional		$144.57	$183.00	$215.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $38.00 / $48.10 / $56.60	Professional	26	$38.00	$48.10	$56.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $106.65 / $135.00 / $158.80	Professional	TC	$106.65	$135.00	$158.80