Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.90 / $37.90 / $37.90	Facility	26	$37.90	$37.90	$37.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.86 / $58.60 / $141.77	Professional		$49.86	$58.60	$141.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $24.94 / $103.46	Professional	26	$19.95	$24.94	$103.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.91 / $35.64 / $99.38	Professional	TC	$29.91	$35.64	$99.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.89 / $109.07 / $186.02	Professional		$38.89	$109.07	$186.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.78 / $47.16 / $82.35	Professional	26	$22.78	$47.16	$82.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.75 / $66.91 / $109.29	Professional	TC	$19.75	$66.91	$109.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $102.26 / $162.04	Professional		$46.00	$102.26	$162.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.95 / $44.36 / $79.27	Professional	26	$26.95	$44.36	$79.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.03 / $55.17 / $82.50	Professional	TC	$10.03	$55.17	$82.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $122.62 / $122.62 / $122.62	Facility	26	$122.62	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.70 / $109.72 / $424.65	Professional		$64.70	$109.72	$424.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.75 / $43.85 / $214.00	Professional	26	$27.75	$43.85	$214.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $36.49 / $59.41 / $272.93	Professional	TC	$36.49	$59.41	$272.93
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $73.45 / $73.45 / $73.45	Facility	26	$73.45	$73.45	$73.45
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.41 / $121.61 / $175.76	Professional		$87.41	$121.61	$175.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.32 / $78.06 / $141.19	Professional		$27.32	$78.06	$141.19
United Facility/Professional Professional Modifier Low / Median / High Price $64.70 / $66.65 / $151.49	Professional		$64.70	$66.65	$151.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $29.23 / $86.83	Professional	26	$28.18	$29.23	$86.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.49 / $37.96 / $85.69	Professional	TC	$36.49	$37.96	$85.69
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $136.19 / $160.19 / $188.40	Professional		$136.19	$160.19	$188.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $54.10 / $63.60	Professional	26	$46.00	$54.10	$63.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $90.20 / $106.10 / $124.80	Professional	TC	$90.20	$106.10	$124.80