Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.43 / $113.43 / $355.08	Facility	26	$113.43	$113.43	$355.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $210.88 / $275.00 / $459.73	Professional		$210.88	$275.00	$459.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $62.17 / $154.51	Professional	26	$55.00	$62.17	$154.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $150.06 / $210.36 / $346.55	Professional	TC	$150.06	$210.36	$346.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.71 / $220.12 / $226.53	Facility	26	$213.71	$220.12	$226.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $313.64 / $581.70 / $985.31	Professional		$313.64	$581.70	$985.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.31 / $137.37 / $185.91	Professional	26	$63.31	$137.37	$185.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $228.76 / $424.12 / $808.75	Professional	TC	$228.76	$424.12	$808.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.42 / $345.91 / $968.26	Professional		$186.42	$345.91	$968.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.62 / $96.75 / $251.66	Professional	26	$55.62	$96.75	$251.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $130.80 / $245.89 / $732.19	Professional	TC	$130.80	$245.89	$732.19
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $434.48 / $561.91 / $561.91	Facility	26	$434.48	$561.91	$561.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $255.69 / $445.87 / $2,220.23	Professional		$255.69	$445.87	$2,220.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.98 / $86.54 / $590.91	Professional	26	$67.98	$86.54	$590.91
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $186.13 / $299.27 / $1,822.59	Professional	TC	$186.13	$299.27	$1,822.59
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $220.12 / $226.53 / $332.94	Facility	26	$220.12	$226.53	$332.94
Midlands Facility/Professional Professional Modifier Low / Median / High Price $404.83 / $593.60 / $723.42	Professional		$404.83	$593.60	$723.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.64 / $193.28 / $348.70	Professional		$59.64	$193.28	$348.70
United Facility/Professional Professional Modifier Low / Median / High Price $238.96 / $297.89 / $526.73	Professional		$238.96	$297.89	$526.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.22 / $78.69 / $146.40	Professional	26	$64.22	$78.69	$146.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.13 / $220.34 / $423.03	Professional	TC	$186.13	$220.34	$423.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $323.98 / $410.10 / $482.40	Professional		$323.98	$410.10	$482.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $114.20 / $134.40	Professional	26	$90.22	$114.20	$134.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $233.68 / $295.80 / $348.10	Professional	TC	$233.68	$295.80	$348.10