Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.98 / $49.98 / $49.98	Facility	26	$49.98	$49.98	$49.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.57 / $128.18 / $260.77	Professional		$100.57	$128.18	$260.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.31 / $30.23 / $154.30	Professional	26	$26.31	$30.23	$154.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.34 / $97.95 / $206.54	Professional	TC	$63.34	$97.95	$206.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.13 / $190.23 / $318.14	Professional		$66.13	$190.23	$318.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.84 / $66.75 / $98.70	Professional	26	$34.84	$66.75	$98.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $124.41 / $231.77	Professional	TC	$35.04	$124.41	$231.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $65.64 / $168.23 / $229.22	Professional		$65.64	$168.23	$229.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.46 / $57.14 / $84.04	Professional	26	$35.46	$57.14	$84.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $12.71 / $100.02 / $171.22	Professional	TC	$12.71	$100.02	$171.22
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $173.52 / $173.52 / $173.52	Facility	26	$173.52	$173.52	$173.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $99.43 / $192.72 / $973.09	Professional		$99.43	$192.72	$973.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.35 / $56.30 / $236.03	Professional	26	$36.35	$56.30	$236.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $55.10 / $123.28 / $750.23	Professional	TC	$55.10	$123.28	$750.23
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $109.95 / $109.95 / $109.95	Facility	26	$109.95	$109.95	$109.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $119.71 / $190.23 / $318.14	Professional		$119.71	$190.23	$318.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.07 / $129.01 / $239.62	Professional		$34.07	$129.01	$239.62
United Facility/Professional Professional Modifier Low / Median / High Price $118.67 / $122.23 / $277.81	Professional		$118.67	$122.23	$277.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.32 / $37.44 / $88.16	Professional	26	$36.32	$37.44	$88.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.32 / $84.79 / $199.54	Professional	TC	$82.32	$84.79	$199.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $245.70 / $289.00 / $339.90	Professional		$245.70	$289.00	$339.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $59.00 / $69.40 / $81.59	Professional	26	$59.00	$69.40	$81.59
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $186.70 / $219.60 / $258.30	Professional	TC	$186.70	$219.60	$258.30