Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.47 / $73.26 / $152.86	Facility	26	$50.47	$73.26	$152.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.32 / $79.94 / $290.00	Professional		$56.32	$79.94	$290.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.14 / $36.13 / $171.21	Professional	26	$29.14	$36.13	$171.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.19 / $34.11 / $154.08	Professional	TC	$20.19	$34.11	$154.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.62 / $139.58 / $178.94	Professional		$101.62	$139.58	$178.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.75 / $71.83 / $92.10	Professional	26	$46.75	$71.83	$92.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.08 / $75.37 / $94.22	Professional	TC	$41.08	$75.37	$94.22
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $59.07 / $84.76 / $180.82	Professional		$59.07	$84.76	$180.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.71 / $38.44 / $82.23	Professional	26	$28.71	$38.44	$82.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.37 / $41.20 / $61.45	Professional	TC	$30.37	$41.20	$61.45
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $72.78 / $145.80 / $145.80	Facility	26	$72.78	$145.80	$145.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $63.93 / $111.35 / $486.90	Professional		$63.93	$111.35	$486.90
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.74 / $66.22 / $196.52	Professional	26	$36.74	$66.22	$196.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.71 / $42.95 / $244.63	Professional	TC	$24.71	$42.95	$244.63
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.09 / $115.54 / $163.87	Professional		$75.09	$115.54	$163.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.75 / $59.17 / $118.67	Professional		$30.75	$59.17	$118.67
United Facility/Professional Professional Modifier Low / Median / High Price $63.76 / $92.74 / $155.91	Professional		$63.76	$92.74	$155.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.15 / $54.63 / $85.95	Professional	26	$35.15	$54.63	$85.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.71 / $41.62 / $68.84	Professional	TC	$24.71	$41.62	$68.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.91 / $132.80 / $156.19	Professional		$104.91	$132.80	$156.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.51 / $61.40 / $72.20	Professional	26	$48.51	$61.40	$72.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $56.41 / $71.40 / $84.00	Professional	TC	$56.41	$71.40	$84.00