Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.06 / $107.69 / $330.00	Professional		$68.06	$107.69	$330.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.64 / $30.51 / $82.00	Professional	26	$18.64	$30.51	$82.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.90 / $77.19 / $297.45	Professional	TC	$49.90	$77.19	$297.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.25 / $107.81 / $174.95	Professional		$86.25	$107.81	$174.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.25 / $29.06 / $48.65	Professional	26	$23.25	$29.06	$48.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.00 / $78.75 / $126.31	Professional	TC	$63.00	$78.75	$126.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $67.69 / $68.53 / $150.00	Professional		$67.69	$68.53	$150.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.11 / $19.70 / $105.80	Professional	26	$19.11	$19.70	$105.80
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.58 / $49.07 / $105.80	Professional	TC	$48.58	$49.07	$105.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.39 / $118.09 / $346.82	Professional		$77.39	$118.09	$346.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.14 / $26.20 / $91.29	Professional	26	$22.14	$26.20	$91.29
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $55.25 / $75.34 / $342.28	Professional	TC	$55.25	$75.34	$342.28
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.80 / $118.67 / $196.97	Professional		$93.80	$118.67	$196.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.01 / $56.10 / $122.33	Professional		$20.01	$56.10	$122.33
United Facility/Professional Professional Modifier Low / Median / High Price $77.39 / $95.93 / $152.78	Professional		$77.39	$95.93	$152.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.14 / $26.20 / $38.83	Professional	26	$22.14	$26.20	$38.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.25 / $66.42 / $117.21	Professional	TC	$55.25	$66.42	$117.21
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $110.52 / $139.90 / $164.60	Professional		$110.52	$139.90	$164.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $38.20 / $45.00	Professional	26	$30.18	$38.20	$45.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $80.34 / $101.70 / $119.60	Professional	TC	$80.34	$101.70	$119.60