Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.29 / $58.29 / $58.29	Facility	26	$58.29	$58.29	$58.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.38 / $120.24 / $267.56	Professional		$102.38	$120.24	$267.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.68 / $35.20 / $64.17	Professional	26	$30.68	$35.20	$64.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.70 / $85.04 / $203.38	Professional	TC	$71.70	$85.04	$203.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.82 / $267.86 / $475.57	Professional		$97.82	$267.86	$475.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.06 / $79.70 / $137.56	Professional	26	$49.06	$79.70	$137.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.32 / $187.57 / $259.41	Professional	TC	$84.32	$187.57	$259.41
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $130.34 / $235.69 / $459.03	Professional		$130.34	$235.69	$459.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.67 / $67.83 / $218.57	Professional	26	$40.67	$67.83	$218.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.94 / $144.53 / $260.23	Professional	TC	$91.94	$144.53	$260.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $271.50 / $271.50 / $271.50	Facility	26	$271.50	$271.50	$271.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $260.26 / $1,070.24	Professional		$123.87	$260.26	$1,070.24
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.06 / $64.97 / $390.67	Professional	26	$42.06	$64.97	$390.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $81.81 / $141.75 / $793.60	Professional	TC	$81.81	$141.75	$793.60
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $164.60 / $164.60 / $164.60	Facility	26	$164.60	$164.60	$164.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.07 / $260.26 / $363.90	Professional		$173.07	$260.26	$363.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.77 / $135.91 / $247.95	Professional		$40.77	$135.91	$247.95
United Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $132.96 / $463.44	Professional		$123.87	$132.96	$463.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.03 / $43.31 / $102.01	Professional	26	$42.03	$43.31	$102.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.81 / $84.26 / $198.42	Professional	TC	$81.81	$84.26	$198.42
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $253.60 / $298.39 / $350.90	Professional		$253.60	$298.39	$350.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $69.80 / $82.10 / $96.60	Professional	26	$69.80	$82.10	$96.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $183.80 / $216.30 / $254.30	Professional	TC	$183.80	$216.30	$254.30