Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.98 / $79.15 / $153.16	Professional		$67.98	$79.15	$153.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.31 / $54.23 / $221.82	Professional	26	$45.31	$54.23	$221.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.67 / $26.94 / $58.83	Professional	TC	$22.67	$26.94	$58.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.84 / $158.96 / $236.60	Professional		$65.84	$158.96	$236.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.52 / $109.00 / $157.47	Professional	26	$48.52	$109.00	$157.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.32 / $54.30 / $79.73	Professional	TC	$17.32	$54.30	$79.73
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $118.17 / $146.22 / $190.72	Professional		$118.17	$146.22	$190.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.13 / $97.90 / $114.84	Professional	26	$79.13	$97.90	$114.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.22 / $41.84 / $65.67	Professional	TC	$33.22	$41.84	$65.67
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $270.97 / $270.97 / $270.97	Facility	26	$270.97	$270.97	$270.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $158.00 / $587.10	Professional		$86.97	$158.00	$587.10
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.65 / $102.45 / $381.48	Professional	26	$60.65	$102.45	$381.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.04 / $34.76 / $205.55	Professional	TC	$24.04	$34.76	$205.55
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $161.41 / $161.41 / $161.41	Facility	26	$161.41	$161.41	$161.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.02 / $158.96 / $221.77	Professional		$107.02	$158.96	$221.77
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.43 / $84.41 / $155.22	Professional		$31.43	$84.41	$155.22
United Facility/Professional Professional Modifier Low / Median / High Price $86.97 / $89.93 / $210.94	Professional		$86.97	$89.93	$210.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.86 / $64.81 / $168.50	Professional	26	$62.86	$64.81	$168.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.04 / $24.76 / $66.95	Professional	TC	$24.04	$24.76	$66.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $154.90 / $182.20 / $214.30	Professional		$154.90	$182.20	$214.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $101.60 / $119.50 / $140.50	Professional	26	$101.60	$119.50	$140.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.30 / $62.70 / $73.80	Professional	TC	$53.30	$62.70	$73.80