Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.06 / $117.46 / $170.06	Professional		$92.06	$117.46	$170.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.60 / $14.25 / $20.73	Professional	26	$12.60	$14.25	$20.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.45 / $103.21 / $149.33	Professional	TC	$79.45	$103.21	$149.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.54 / $202.44 / $318.10	Professional		$95.54	$202.44	$318.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $29.34 / $38.43	Professional	26	$11.75	$29.34	$38.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.85 / $173.25 / $281.24	Professional	TC	$84.85	$173.25	$281.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $93.86 / $129.51 / $209.64	Professional		$93.86	$129.51	$209.64
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.97 / $17.80 / $35.86	Professional	26	$10.97	$17.80	$35.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.93 / $107.85 / $184.52	Professional	TC	$82.93	$107.85	$184.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $34.29 / $34.29 / $100.00	Facility	26	$34.29	$34.29	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $98.38 / $145.72 / $318.10	Professional		$98.38	$145.72	$318.10
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $20.22 / $46.67	Professional	26	$14.13	$20.22	$46.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $83.44 / $120.62 / $278.33	Professional	TC	$83.44	$120.62	$278.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.00 / $238.56 / $318.10	Professional		$141.00	$238.56	$318.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.73 / $123.44 / $232.08	Professional		$14.73	$123.44	$232.08
United Facility/Professional Professional Modifier Low / Median / High Price $96.63 / $140.84 / $236.96	Professional		$96.63	$140.84	$236.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.97 / $19.54 / $36.24	Professional	26	$13.97	$19.54	$36.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.44 / $120.62 / $202.93	Professional	TC	$83.44	$120.62	$202.93
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $177.51 / $224.70 / $233.70	Professional		$177.51	$224.70	$233.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.75 / $25.00 / $26.00	Professional	26	$19.75	$25.00	$26.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $157.76 / $199.70 / $207.70	Professional	TC	$157.76	$199.70	$207.70