Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.35 / $61.46 / $99.31	Facility	26	$32.35	$61.46	$99.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.60 / $166.47 / $265.48	Professional		$114.60	$166.47	$265.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.63 / $23.89 / $53.38	Professional	26	$20.63	$23.89	$53.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.69 / $134.13 / $206.56	Professional	TC	$92.69	$134.13	$206.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.24 / $298.58 / $505.02	Professional		$142.24	$298.58	$505.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.72 / $49.83 / $74.39	Professional	26	$23.72	$49.83	$74.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.78 / $254.00 / $415.18	Professional	TC	$119.78	$254.00	$415.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $166.58 / $392.39	Professional		$109.05	$166.58	$392.39
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.62 / $33.53 / $71.16	Professional	26	$21.62	$33.53	$71.16
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.84 / $132.77 / $321.62	Professional	TC	$84.84	$132.77	$321.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $174.32 / $174.32 / $174.32	Facility	26	$174.32	$174.32	$174.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $147.66 / $271.08 / $1,035.17	Professional		$147.66	$271.08	$1,035.17
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $48.98 / $303.79	Professional	26	$25.98	$48.98	$303.79
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $109.51 / $207.10 / $922.24	Professional	TC	$109.51	$207.10	$922.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $186.94 / $286.43 / $347.16	Professional		$186.94	$286.43	$347.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.18 / $116.30 / $219.07	Professional		$25.18	$116.30	$219.07
United Facility/Professional Professional Modifier Low / Median / High Price $136.94 / $228.84 / $447.68	Professional		$136.94	$228.84	$447.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $44.36 / $63.12	Professional	26	$25.98	$44.36	$63.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.39 / $179.89 / $270.50	Professional	TC	$105.39	$179.89	$270.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $179.17 / $226.80 / $266.80	Professional		$179.17	$226.80	$266.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $33.58 / $42.50 / $50.00	Professional	26	$33.58	$42.50	$50.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $145.60 / $184.30 / $216.80	Professional	TC	$145.60	$184.30	$216.80