Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.03 / $97.16 / $203.02	Facility	26	$67.03	$97.16	$203.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.34 / $106.04 / $392.52	Professional		$71.34	$106.04	$392.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.84 / $222.00	Professional	26	$38.90	$57.84	$222.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.33 / $36.60 / $165.73	Professional	TC	$24.33	$36.60	$165.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.91 / $164.70 / $213.78	Professional		$119.91	$164.70	$213.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.97 / $96.02 / $119.47	Professional	26	$60.97	$96.02	$119.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.33 / $80.95 / $101.20	Professional	TC	$44.33	$80.95	$101.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $70.09 / $94.06 / $253.88	Professional		$70.09	$94.06	$253.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.74 / $51.73 / $129.66	Professional	26	$37.74	$51.73	$129.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.35 / $43.91 / $102.49	Professional	TC	$32.35	$43.91	$102.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $95.51 / $190.77 / $190.77	Facility	26	$95.51	$190.77	$190.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $141.88 / $622.15	Professional		$80.78	$141.88	$622.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.60 / $86.69 / $262.07	Professional	26	$48.60	$86.69	$262.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.98 / $46.33 / $264.17	Professional	TC	$27.98	$46.33	$264.17
Midlands Facility/Professional Professional Modifier Low / Median / High Price $94.75 / $144.63 / $193.69	Professional		$94.75	$144.63	$193.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.04 / $71.20 / $140.32	Professional		$38.04	$71.20	$140.32
United Facility/Professional Professional Modifier Low / Median / High Price $77.26 / $119.41 / $191.05	Professional		$77.26	$119.41	$191.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.49 / $67.62 / $111.85	Professional	26	$46.49	$67.62	$111.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.93 / $44.76 / $76.11	Professional	TC	$27.93	$44.76	$76.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.87 / $156.80 / $184.50	Professional		$123.87	$156.80	$184.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $63.75 / $80.70 / $95.00	Professional	26	$63.75	$80.70	$95.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $60.12 / $76.09 / $89.50	Professional	TC	$60.12	$76.09	$89.50