Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.20 / $46.20 / $46.20	Facility	26	$46.20	$46.20	$46.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $103.15 / $235.96	Professional		$73.84	$103.15	$235.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.69 / $27.93 / $51.69	Professional	26	$22.69	$27.93	$51.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.16 / $75.22 / $184.26	Professional	TC	$51.16	$75.22	$184.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.41 / $151.74 / $267.16	Professional		$57.41	$151.74	$267.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.98 / $57.64 / $82.86	Professional	26	$18.98	$57.64	$82.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.42 / $131.90 / $179.35	Professional	TC	$38.42	$131.90	$179.35
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $100.25 / $205.52 / $387.75	Professional		$100.25	$205.52	$387.75
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.65 / $54.36 / $203.47	Professional	26	$26.65	$54.36	$203.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.59 / $130.86 / $184.28	Professional	TC	$73.59	$130.86	$184.28
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $149.85 / $149.85 / $149.85	Facility	26	$149.85	$149.85	$149.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $70.55 / $151.74 / $730.19	Professional		$70.55	$151.74	$730.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.67 / $33.93 / $200.25	Professional	26	$25.67	$33.93	$200.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.88 / $82.65 / $531.07	Professional	TC	$44.88	$82.65	$531.07
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $84.16 / $84.16 / $84.16	Facility	26	$84.16	$84.16	$84.16
Midlands Facility/Professional Professional Modifier Low / Median / High Price $133.43 / $196.50 / $267.16	Professional		$133.43	$196.50	$267.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $32.72 / $118.82 / $216.89	Professional		$32.72	$118.82	$216.89
United Facility/Professional Professional Modifier Low / Median / High Price $107.73 / $110.96 / $228.12	Professional		$107.73	$110.96	$228.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.86 / $33.92 / $71.73	Professional	26	$32.86	$33.92	$71.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.79 / $77.03 / $159.60	Professional	TC	$74.79	$77.03	$159.60
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $222.40 / $261.70 / $307.70	Professional		$222.40	$261.70	$307.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $56.20 / $66.09 / $77.70	Professional	26	$56.20	$66.09	$77.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $166.20 / $195.60 / $230.00	Professional	TC	$166.20	$195.60	$230.00