Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.39 / $101.44 / $276.95	Facility	26	$49.39	$101.44	$276.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $148.19 / $232.72 / $303.50	Professional		$148.19	$232.72	$303.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $54.71 / $153.22	Professional	26	$48.57	$54.71	$153.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.81 / $145.90 / $229.28	Professional	TC	$94.81	$145.90	$229.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.45 / $172.47 / $177.50	Facility	26	$167.45	$172.47	$177.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $202.47 / $356.07 / $603.71	Professional		$202.47	$356.07	$603.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $121.78 / $166.63	Professional	26	$56.48	$121.78	$166.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.30 / $233.00 / $467.02	Professional	TC	$145.30	$233.00	$467.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $132.80 / $245.49 / $737.71	Professional		$132.80	$245.49	$737.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.66 / $80.45 / $229.01	Professional	26	$49.66	$80.45	$229.01
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.14 / $156.08 / $431.88	Professional	TC	$83.14	$156.08	$431.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $502.08 / $502.08	Facility	26	$388.00	$502.08	$502.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $168.29 / $298.12 / $1,547.04	Professional		$168.29	$298.12	$1,547.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.41 / $72.00 / $363.24	Professional	26	$56.41	$72.00	$363.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $107.47 / $183.86 / $1,263.33	Professional	TC	$107.47	$183.86	$1,263.33
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $172.47 / $177.50 / $297.66	Facility	26	$172.47	$177.50	$297.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $285.50 / $338.43 / $511.74	Professional		$285.50	$338.43	$511.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.43 / $140.55 / $248.44	Professional		$53.43	$140.55	$248.44
United Facility/Professional Professional Modifier Low / Median / High Price $159.38 / $199.22 / $348.82	Professional		$159.38	$199.22	$348.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.29 / $68.31 / $126.06	Professional	26	$55.29	$68.31	$126.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.59 / $129.49 / $237.90	Professional	TC	$102.59	$129.49	$237.90
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $229.18 / $290.10 / $341.30	Professional		$229.18	$290.10	$341.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $80.58 / $102.00 / $120.00	Professional	26	$80.58	$102.00	$120.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $148.52 / $188.00 / $221.20	Professional	TC	$148.52	$188.00	$221.20