Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.64 / $160.81 / $259.85	Facility	26	$84.64	$160.81	$259.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.22 / $146.57 / $466.00	Professional		$97.22	$146.57	$466.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.13 / $84.64 / $310.00	Professional	26	$50.13	$84.64	$310.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.87 / $46.20 / $194.77	Professional	TC	$31.87	$46.20	$194.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.53 / $220.90 / $283.01	Professional		$158.53	$220.90	$283.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.43 / $139.51 / $192.45	Professional	26	$89.43	$139.51	$192.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.44 / $94.91 / $122.50	Professional	TC	$51.44	$94.91	$122.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $93.54 / $132.86 / $295.27	Professional		$93.54	$132.86	$295.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.51 / $74.43 / $174.29	Professional	26	$55.51	$74.43	$174.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $55.85 / $96.70	Professional	TC	$38.02	$55.85	$96.70
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $140.60 / $284.70 / $284.70	Facility	26	$140.60	$284.70	$284.70
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.40 / $200.73 / $865.60	Professional		$109.40	$200.73	$865.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $71.58 / $129.53 / $382.35	Professional	26	$71.58	$129.53	$382.35
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.85 / $56.83 / $307.58	Professional	TC	$35.85	$56.83	$307.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $135.60 / $201.49 / $281.02	Professional		$135.60	$201.49	$281.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.59 / $97.36 / $186.00	Professional		$45.59	$97.36	$186.00
United Facility/Professional Professional Modifier Low / Median / High Price $104.64 / $160.80 / $252.70	Professional		$104.64	$160.80	$252.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.45 / $106.43 / $169.29	Professional	26	$68.45	$106.43	$169.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.40 / $52.62 / $89.46	Professional	TC	$34.40	$52.62	$89.46
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $164.48 / $208.20 / $244.90	Professional		$164.48	$208.20	$244.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $93.85 / $118.80 / $139.69	Professional	26	$93.85	$118.80	$139.69
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.63 / $89.40 / $105.20	Professional	TC	$70.63	$89.40	$105.20