Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.65 / $104.02 / $283.99	Facility	26	$50.65	$104.02	$283.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.73 / $272.22 / $397.82	Professional		$200.73	$272.22	$397.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.85 / $55.59 / $255.77	Professional	26	$52.85	$55.59	$255.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.96 / $203.80 / $279.64	Professional	TC	$144.96	$203.80	$279.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $175.41 / $180.67 / $185.93	Facility	26	$175.41	$180.67	$185.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $248.28 / $486.87 / $713.35	Professional		$248.28	$486.87	$713.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.88 / $124.89 / $170.89	Professional	26	$57.88	$124.89	$170.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.78 / $360.53 / $570.97	Professional	TC	$192.78	$360.53	$570.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.17 / $329.04 / $768.50	Professional		$177.17	$329.04	$768.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.91 / $82.43 / $200.07	Professional	26	$50.91	$82.43	$200.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.26 / $237.33 / $612.45	Professional	TC	$126.26	$237.33	$612.45
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $397.76 / $514.88 / $514.88	Facility	26	$397.76	$514.88	$514.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $228.54 / $400.98 / $1,627.19	Professional		$228.54	$400.98	$1,627.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $73.84 / $345.18	Professional	26	$57.84	$73.84	$345.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $166.17 / $236.71 / $1,330.47	Professional	TC	$166.17	$236.71	$1,330.47
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $180.67 / $185.93 / $305.33	Facility	26	$180.67	$185.93	$305.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $385.45 / $464.77 / $688.35	Professional		$385.45	$464.77	$688.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.74 / $187.29 / $331.26	Professional		$54.74	$187.29	$331.26
United Facility/Professional Professional Modifier Low / Median / High Price $218.16 / $270.55 / $471.64	Professional		$218.16	$270.55	$471.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $70.02 / $129.22	Professional	26	$57.84	$70.02	$129.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.06 / $196.71 / $342.41	Professional	TC	$151.06	$196.71	$342.41
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $308.26 / $390.20 / $459.00	Professional		$308.26	$390.20	$459.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $82.63 / $104.60 / $123.10	Professional	26	$82.63	$104.60	$123.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $225.62 / $285.60 / $336.00	Professional	TC	$225.62	$285.60	$336.00