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 $152.32 / $272.27 / $384.82	Professional		$152.32	$272.27	$384.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.37 / $59.49 / $256.80	Professional	26	$53.37	$59.49	$256.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.94 / $137.04 / $283.70	Professional	TC	$98.94	$137.04	$283.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $193.34 / $199.14 / $204.94	Facility	26	$193.34	$199.14	$204.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.22 / $365.35 / $757.49	Professional		$251.22	$365.35	$757.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $121.78 / $165.62	Professional	26	$56.48	$121.78	$165.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.76 / $243.04 / $598.02	Professional	TC	$166.76	$243.04	$598.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $135.91 / $251.37 / $791.18	Professional		$135.91	$251.37	$791.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.66 / $86.58 / $204.45	Professional	26	$49.66	$86.58	$204.45
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.26 / $161.96 / $586.92	Professional	TC	$86.26	$161.96	$586.92
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $498.88 / $498.88	Facility	26	$388.00	$498.88	$498.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $172.25 / $311.26 / $1,708.01	Professional		$172.25	$311.26	$1,708.01
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.82 / $77.69 / $384.71	Professional	26	$60.82	$77.69	$384.71
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $111.43 / $192.12 / $2,023.00	Professional	TC	$111.43	$192.12	$2,023.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $199.14 / $204.94 / $295.86	Facility	26	$199.14	$204.94	$295.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $292.50 / $365.35 / $569.00	Professional		$292.50	$365.35	$569.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.43 / $143.60 / $254.26	Professional		$53.43	$143.60	$254.26
United Facility/Professional Professional Modifier Low / Median / High Price $164.42 / $203.91 / $357.03	Professional		$164.42	$203.91	$357.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.74 / $72.00 / $126.07	Professional	26	$57.74	$72.00	$126.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.55 / $134.25 / $274.07	Professional	TC	$106.55	$134.25	$274.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $234.71 / $297.10 / $349.60	Professional		$234.71	$297.10	$349.60
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 $154.13 / $195.10 / $229.50	Professional	TC	$154.13	$195.10	$229.50