Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.97 / $72.97 / $72.97	Facility	26	$72.97	$72.97	$72.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.42 / $73.81 / $272.00	Professional		$57.42	$73.81	$272.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.39 / $35.76 / $72.97	Professional	26	$26.39	$35.76	$72.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.15 / $38.43 / $85.51	Professional	TC	$29.15	$38.43	$85.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.33 / $132.60 / $165.75	Professional		$64.33	$132.60	$165.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.38 / $55.83 / $71.70	Professional	26	$29.38	$55.83	$71.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.25 / $76.77 / $95.96	Professional	TC	$34.25	$76.77	$95.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $59.72 / $90.44 / $283.30	Professional		$59.72	$90.44	$283.30
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.58 / $41.76 / $121.57	Professional	26	$26.58	$41.76	$121.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.90 / $46.81 / $156.01	Professional	TC	$31.90	$46.81	$156.01
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $64.69 / $122.62 / $122.62	Facility	26	$64.69	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $66.52 / $118.65 / $717.26	Professional		$66.52	$118.65	$717.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $32.40 / $56.36 / $330.63	Professional	26	$32.40	$56.36	$330.63
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.17 / $56.24 / $563.89	Professional	TC	$32.17	$56.24	$563.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $88.86 / $119.84 / $160.93	Professional		$88.86	$119.84	$160.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.85 / $57.82 / $115.45	Professional		$29.85	$57.82	$115.45
United Facility/Professional Professional Modifier Low / Median / High Price $61.78 / $92.48 / $152.76	Professional		$61.78	$92.48	$152.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.00 / $45.09 / $74.58	Professional	26	$31.00	$45.09	$74.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.78 / $44.77 / $76.11	Professional	TC	$30.78	$44.77	$76.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $94.64 / $119.80 / $140.90	Professional		$94.64	$119.80	$140.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $40.36 / $51.10 / $60.10	Professional	26	$40.36	$51.10	$60.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $54.27 / $68.70 / $80.80	Professional	TC	$54.27	$68.70	$80.80