Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.50 / $97.58 / $267.45	Facility	26	$47.50	$97.58	$267.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.46 / $236.72 / $820.00	Professional		$133.46	$236.72	$820.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $55.00 / $268.58	Professional	26	$49.60	$55.00	$268.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.10 / $131.86 / $220.00	Professional	TC	$82.10	$131.86	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.33 / $167.20 / $172.07	Facility	26	$162.33	$167.20	$172.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $191.30 / $318.92 / $570.97	Professional		$191.30	$318.92	$570.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.39 / $117.13 / $163.99	Professional	26	$54.39	$117.13	$163.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.25 / $200.48 / $438.55	Professional	TC	$138.25	$200.48	$438.55
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.30 / $220.44 / $721.26	Professional		$119.30	$220.44	$721.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.80 / $77.51 / $171.97	Professional	26	$47.80	$77.51	$171.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.50 / $134.43 / $575.94	Professional	TC	$71.50	$134.43	$575.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $373.44 / $482.96 / $482.96	Facility	26	$373.44	$482.96	$482.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $150.13 / $270.54 / $1,593.12	Professional		$150.13	$270.54	$1,593.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.27 / $69.28 / $325.83	Professional	26	$54.27	$69.28	$325.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $91.62 / $160.75 / $1,318.35	Professional	TC	$91.62	$160.75	$1,318.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $167.20 / $172.07 / $286.20	Facility	26	$167.20	$172.07	$286.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $256.20 / $302.55 / $481.00	Professional		$256.20	$302.55	$481.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $51.67 / $117.50 / $222.82	Professional		$51.67	$117.50	$222.82
United Facility/Professional Professional Modifier Low / Median / High Price $143.27 / $177.74 / $311.20	Professional		$143.27	$177.74	$311.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $63.84 / $120.92	Professional	26	$53.20	$63.84	$120.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.48 / $110.43 / $210.56	Professional	TC	$89.48	$110.43	$210.56
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $205.32 / $259.89 / $305.80	Professional		$205.32	$259.89	$305.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.58 / $98.20 / $115.50	Professional	26	$77.58	$98.20	$115.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $127.74 / $161.69 / $190.30	Professional	TC	$127.74	$161.69	$190.30