Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.69 / $60.21 / $97.29	Facility	26	$31.69	$60.21	$97.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.64 / $128.43 / $342.26	Professional		$114.64	$128.43	$342.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $23.85 / $75.00	Professional	26	$14.49	$23.85	$75.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.00 / $106.95 / $167.19	Professional	TC	$93.00	$106.95	$167.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.35 / $296.58 / $502.30	Professional		$134.35	$296.58	$502.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.98 / $45.36 / $57.65	Professional	26	$17.98	$45.36	$57.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.58 / $239.82 / $413.82	Professional	TC	$117.58	$239.82	$413.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $108.61 / $179.21 / $424.07	Professional		$108.61	$179.21	$424.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.33 / $27.49 / $72.73	Professional	26	$21.33	$27.49	$72.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $84.56 / $143.91 / $360.52	Professional	TC	$84.56	$143.91	$360.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $102.96 / $102.96 / $102.96	Facility	26	$102.96	$102.96	$102.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $143.53 / $269.70 / $1,021.59	Professional		$143.53	$269.70	$1,021.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.53 / $43.93 / $203.09	Professional	26	$22.53	$43.93	$203.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $110.27 / $211.75 / $934.78	Professional	TC	$110.27	$211.75	$934.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $175.00 / $269.47 / $321.38	Professional		$175.00	$269.47	$321.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.03 / $111.69 / $217.46	Professional		$24.03	$111.69	$217.46
United Facility/Professional Professional Modifier Low / Median / High Price $137.55 / $228.08 / $444.84	Professional		$137.55	$228.08	$444.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $37.96 / $62.78	Professional	26	$23.57	$37.96	$62.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.11 / $191.82 / $287.67	Professional	TC	$106.11	$191.82	$287.67
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $178.15 / $225.50 / $265.39	Professional		$178.15	$225.50	$265.39
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $33.10 / $41.90 / $49.30	Professional	26	$33.10	$41.90	$49.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $145.04 / $183.60 / $216.10	Professional	TC	$145.04	$183.60	$216.10