Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.32 / $49.32 / $49.32	Facility	26	$49.32	$49.32	$49.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.54 / $47.28 / $95.54	Professional		$40.54	$47.28	$95.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.96 / $29.88 / $59.10	Professional	26	$25.96	$29.88	$59.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.60 / $17.39 / $41.18	Professional	TC	$14.60	$17.39	$41.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.14 / $92.00 / $141.72	Professional		$37.14	$92.00	$141.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.40 / $59.87 / $90.73	Professional	26	$24.40	$59.87	$90.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.74 / $37.00 / $52.85	Professional	TC	$12.74	$37.00	$52.85
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.22 / $85.75 / $143.97	Professional		$53.22	$85.75	$143.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.99 / $55.55 / $138.41	Professional	26	$34.99	$55.55	$138.41
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.27 / $29.01 / $45.50	Professional	TC	$16.27	$29.01	$45.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $155.94 / $155.94 / $155.94	Facility	26	$155.94	$155.94	$155.94
Medica Facility/Professional Professional Modifier Low / Median / High Price $52.67 / $92.00 / $473.28	Professional		$52.67	$92.00	$473.28
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.15 / $60.05 / $346.00	Professional	26	$36.15	$60.05	$346.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $17.51 / $28.51 / $330.22	Professional	TC	$17.51	$28.51	$330.22
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $89.86 / $89.86 / $89.86	Facility	26	$89.86	$89.86	$89.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.09 / $98.41 / $129.35	Professional		$66.09	$98.41	$129.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $22.51 / $52.12 / $95.85	Professional		$22.51	$52.12	$95.85
United Facility/Professional Professional Modifier Low / Median / High Price $53.64 / $55.30 / $125.69	Professional		$53.64	$55.30	$125.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.36 / $36.18 / $84.70	Professional	26	$34.36	$36.18	$84.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.51 / $18.96 / $40.99	Professional	TC	$17.51	$18.96	$40.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.90 / $112.80 / $132.69	Professional		$95.90	$112.80	$132.69
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $58.40 / $68.80 / $80.90	Professional	26	$58.40	$68.80	$80.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $37.40 / $44.10 / $51.80	Professional	TC	$37.40	$44.10	$51.80