Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.38 / $37.65 / $69.67	Facility	26	$16.38	$37.65	$69.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.17 / $94.81 / $275.00	Professional		$84.17	$94.81	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $12.35 / $55.00	Professional	26	$11.23	$12.35	$55.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.93 / $82.83 / $220.00	Professional	TC	$72.93	$82.83	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $454.52 / $468.16 / $481.79	Facility	26	$454.52	$468.16	$481.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.17 / $236.59 / $374.48	Professional		$126.17	$236.59	$374.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $26.37 / $32.97	Professional	26	$12.42	$26.37	$32.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.44 / $210.21 / $262.77	Professional	TC	$116.44	$210.21	$262.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $86.12 / $130.24 / $372.63	Professional		$86.12	$130.24	$372.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.94 / $15.89 / $44.60	Professional	26	$10.94	$15.89	$44.60
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.19 / $117.50 / $237.69	Professional	TC	$75.19	$117.50	$237.69
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.36 / $110.80 / $110.80	Facility	26	$85.36	$110.80	$110.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $116.48 / $169.53 / $876.62	Professional		$116.48	$169.53	$876.62
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.12 / $15.78 / $270.04	Professional	26	$12.12	$15.78	$270.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $103.15 / $141.33 / $820.61	Professional	TC	$103.15	$141.33	$820.61
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $65.94 / $481.79 / $481.79	Facility	26	$65.94	$481.79	$481.79
Midlands Facility/Professional Professional Modifier Low / Median / High Price $136.60 / $193.29 / $339.64	Professional		$136.60	$193.29	$339.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $135.30 / $135.30 / $422.20	Professional		$135.30	$135.30	$422.20
United Facility/Professional Professional Modifier Low / Median / High Price $111.72 / $138.90 / $241.53	Professional		$111.72	$138.90	$241.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.23 / $15.76 / $36.18	Professional	26	$12.23	$15.76	$36.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.45 / $122.11 / $214.06	Professional	TC	$98.45	$122.11	$214.06
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $146.07 / $184.90 / $217.50	Professional		$146.07	$184.90	$217.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $21.60 / $25.40	Professional	26	$17.05	$21.60	$25.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $129.01 / $163.30 / $192.10	Professional	TC	$129.01	$163.30	$192.10