Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.53 / $135.02 / $249.76	Facility	26	$83.53	$135.02	$249.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.57 / $95.13 / $372.95	Professional		$55.57	$95.13	$372.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $68.13 / $263.18	Professional	26	$37.99	$68.13	$263.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.42 / $27.00 / $109.76	Professional	TC	$17.42	$27.00	$109.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.66 / $140.77 / $144.87	Facility	26	$136.66	$140.77	$144.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.21 / $151.26 / $189.08	Professional		$129.21	$151.26	$189.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $92.21 / $106.27 / $132.84	Professional	26	$92.21	$106.27	$132.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.00 / $44.99 / $56.24	Professional	TC	$37.00	$44.99	$56.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $59.40 / $99.53 / $216.00	Professional		$59.40	$99.53	$216.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.94 / $70.25 / $155.52	Professional	26	$42.94	$70.25	$155.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.47 / $26.34 / $51.04	Professional	TC	$16.47	$26.34	$51.04
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $140.77 / $140.77 / $140.77	Facility	26	$140.77	$140.77	$140.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $68.70 / $98.00 / $239.12	Professional		$68.70	$98.00	$239.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $49.81 / $58.96 / $402.86	Professional	26	$49.81	$58.96	$402.86
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.89 / $23.44 / $402.86	Professional	TC	$18.89	$23.44	$402.86
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $140.77 / $144.87 / $256.20	Facility	26	$140.77	$144.87	$256.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $137.49 / $172.95	Professional		$105.00	$137.49	$172.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.51 / $45.83 / $111.04	Professional		$19.51	$45.83	$111.04
United Facility/Professional Professional Modifier Low / Median / High Price $68.16 / $77.70 / $121.16	Professional		$68.16	$77.70	$121.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.81 / $58.96 / $87.39	Professional	26	$49.81	$58.96	$87.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.89 / $21.60 / $34.97	Professional	TC	$18.89	$21.60	$34.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.91 / $121.40 / $142.80	Professional		$95.91	$121.40	$142.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $67.70 / $85.70 / $100.80	Professional	26	$67.70	$85.70	$100.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $28.20 / $35.70 / $42.00	Professional	TC	$28.20	$35.70	$42.00