Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.69 / $75.69 / $91.22	Facility		$75.69	$75.69	$91.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.55 / $42.55 / $42.55	Facility	26	$42.55	$42.55	$42.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.84 / $46.58 / $93.85	Professional		$39.84	$46.58	$93.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.40 / $26.53 / $72.00	Professional	26	$22.40	$26.53	$72.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.48 / $20.77 / $46.85	Professional	TC	$11.48	$20.77	$46.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.09 / $88.28 / $139.31	Professional		$32.09	$88.28	$139.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.14 / $53.00 / $78.08	Professional	26	$24.14	$53.00	$78.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $9.89 / $27.17 / $49.40	Professional	TC	$9.89	$27.17	$49.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.28 / $71.48 / $102.97	Professional		$52.28	$71.48	$102.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.23 / $48.65 / $192.75	Professional	26	$30.23	$48.65	$192.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.71 / $21.29 / $192.75	Professional	TC	$12.71	$21.29	$192.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $53.36 / $75.48 / $152.82	Facility		$53.36	$75.48	$152.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $134.74 / $134.74 / $134.74	Facility	26	$134.74	$134.74	$134.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $84.72 / $342.09	Professional		$50.93	$84.72	$342.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $48.72 / $250.96	Professional	26	$29.80	$48.72	$250.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.42 / $24.13 / $250.96	Professional	TC	$19.42	$24.13	$250.96
Midlands Facility/Professional Facility Modifier Low / Median / High Price $62.66 / $90.99 / $109.90	Facility		$62.66	$90.99	$109.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $78.76 / $78.76 / $78.76	Facility	26	$78.76	$78.76	$78.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $62.66 / $93.54 / $120.57	Professional		$62.66	$93.54	$120.57
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.14 / $49.80 / $91.84	Professional		$25.14	$49.80	$91.84
United Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $52.04 / $119.01	Professional		$52.00	$52.04	$119.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.23 / $32.21 / $86.76	Professional	26	$31.23	$32.21	$86.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.77 / $21.39 / $41.54	Professional	TC	$20.77	$21.39	$41.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $109.50 / $128.69	Professional		$93.00	$109.50	$128.69
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $59.40 / $69.90	Professional	26	$50.50	$59.40	$69.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $42.60 / $50.10 / $58.90	Professional	TC	$42.60	$50.10	$58.90