Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.62 / $106.62 / $291.08	Facility	26	$106.62	$106.62	$291.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $137.27 / $223.90 / $791.00	Professional		$137.27	$223.90	$791.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $57.29 / $223.00	Professional	26	$51.30	$57.29	$223.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.15 / $130.33 / $220.00	Professional	TC	$81.15	$130.33	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.72 / $183.05 / $188.38	Facility	26	$177.72	$183.05	$188.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.27 / $328.99 / $582.36	Professional		$195.27	$328.99	$582.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.29 / $127.99 / $180.17	Professional	26	$59.29	$127.99	$180.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.10 / $198.16 / $437.12	Professional	TC	$136.10	$198.16	$437.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $122.53 / $226.29 / $722.98	Professional		$122.53	$226.29	$722.98
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.17 / $84.38 / $231.70	Professional	26	$52.17	$84.38	$231.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.36 / $132.29 / $563.79	Professional	TC	$70.36	$132.29	$563.79
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $407.44 / $527.60 / $527.60	Facility	26	$407.44	$527.60	$527.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $154.28 / $275.33 / $1,561.56	Professional		$154.28	$275.33	$1,561.56
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $59.44 / $75.88 / $386.35	Professional	26	$59.44	$75.88	$386.35
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $90.18 / $158.22 / $1,649.00	Professional	TC	$90.18	$158.22	$1,649.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $183.05 / $188.38 / $313.02	Facility	26	$183.05	$188.38	$313.02
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.56 / $309.39 / $485.00	Professional		$263.56	$309.39	$485.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.25 / $117.50 / $231.21	Professional		$56.25	$117.50	$231.21
United Facility/Professional Professional Modifier Low / Median / High Price $147.26 / $182.63 / $319.77	Professional		$147.26	$182.63	$319.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.27 / $69.92 / $132.43	Professional	26	$58.27	$69.92	$132.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.08 / $108.71 / $206.12	Professional	TC	$86.08	$108.71	$206.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $210.38 / $266.30 / $313.30	Professional		$210.38	$266.30	$313.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $84.69 / $107.20 / $126.10	Professional	26	$84.69	$107.20	$126.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $125.77 / $159.19 / $187.20	Professional	TC	$125.77	$159.19	$187.20