Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.99 / $50.06 / $91.92	Facility	26	$20.99	$50.06	$91.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.59 / $43.86 / $81.50	Professional		$37.59	$43.86	$81.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $15.19 / $26.66	Professional	26	$14.08	$15.19	$26.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $27.68 / $53.95	Professional	TC	$23.51	$27.68	$53.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $366.99 / $378.00 / $389.01	Facility	26	$366.99	$378.00	$389.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.06 / $107.82 / $134.78	Professional		$47.06	$107.82	$134.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.72 / $37.22 / $50.79	Professional	26	$16.72	$37.22	$50.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.64 / $70.44 / $88.24	Professional	TC	$29.64	$70.44	$88.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.78 / $60.83 / $153.21	Professional		$40.78	$60.83	$153.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.24 / $22.53 / $70.73	Professional	26	$15.24	$22.53	$70.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.54 / $40.04 / $82.47	Professional	TC	$25.54	$40.04	$82.47
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $80.00 / $80.00 / $80.00	Facility	26	$80.00	$80.00	$80.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.81 / $66.73 / $301.08	Professional		$42.81	$66.73	$301.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $21.88 / $104.20	Professional	26	$16.80	$21.88	$104.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $34.65 / $196.89	Professional	TC	$26.01	$34.65	$196.89
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $91.26 / $389.01 / $389.01	Facility	26	$91.26	$389.01	$389.01
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.73 / $91.78 / $157.36	Professional		$66.73	$91.78	$157.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.70 / $61.70 / $116.90	Professional		$61.70	$61.70	$116.90
United Facility/Professional Professional Modifier Low / Median / High Price $42.81 / $51.57 / $86.13	Professional		$42.81	$51.57	$86.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.80 / $21.88 / $38.92	Professional	26	$16.80	$21.88	$38.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $33.25 / $55.79	Professional	TC	$26.01	$33.25	$55.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.70 / $85.70 / $100.80	Professional		$67.70	$85.70	$100.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $23.86 / $30.20 / $35.50	Professional	26	$23.86	$30.20	$35.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $43.85 / $55.50 / $65.30	Professional	TC	$43.85	$55.50	$65.30