Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.29 / $40.29 / $40.29	Facility	26	$40.29	$40.29	$40.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.47 / $98.22 / $199.12	Professional		$72.47	$98.22	$199.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.21 / $24.41 / $573.76	Professional	26	$21.21	$24.41	$573.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.17 / $73.81 / $155.27	Professional	TC	$46.17	$73.81	$155.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.06 / $182.65 / $256.19	Professional		$56.06	$182.65	$256.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $49.56 / $76.94	Professional	26	$21.75	$49.56	$76.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.31 / $109.01 / $176.15	Professional	TC	$34.31	$109.01	$176.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $139.47 / $173.46 / $371.15	Professional		$139.47	$173.46	$371.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.25 / $46.06 / $108.37	Professional	26	$37.25	$46.06	$108.37
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.13 / $110.28 / $128.66	Professional	TC	$86.13	$110.28	$128.66
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $127.16 / $127.16 / $127.16	Facility	26	$127.16	$127.16	$127.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.51 / $141.75 / $750.04	Professional		$69.51	$141.75	$750.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $29.13 / $30.32 / $179.95	Professional	26	$29.13	$30.32	$179.95
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $39.51 / $63.87 / $570.15	Professional	TC	$39.51	$63.87	$570.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $110.00 / $110.00 / $110.00	Facility	26	$110.00	$110.00	$110.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $112.19 / $166.66 / $256.19	Professional		$112.19	$166.66	$256.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.00 / $99.70 / $183.22	Professional		$28.00	$99.70	$183.22
United Facility/Professional Professional Modifier Low / Median / High Price $87.07 / $89.68 / $194.33	Professional		$87.07	$89.68	$194.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.27 / $30.18 / $68.59	Professional	26	$29.27	$30.18	$68.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.77 / $59.50 / $115.54	Professional	TC	$57.77	$59.50	$115.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $187.80 / $220.90 / $259.80	Professional		$187.80	$220.90	$259.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $47.70 / $56.10 / $65.90	Professional	26	$47.70	$56.10	$65.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $140.10 / $164.90 / $193.90	Professional	TC	$140.10	$164.90	$193.90