Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.15 / $84.03 / $169.92	Facility	26	$45.15	$84.03	$169.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.45 / $136.13 / $267.51	Professional		$109.45	$136.13	$267.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $46.35 / $174.13	Professional	26	$31.76	$46.35	$174.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.54 / $93.58 / $140.02	Professional	TC	$79.54	$93.58	$140.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.43 / $107.56 / $110.70	Facility	26	$104.43	$107.56	$110.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.91 / $354.49 / $443.12	Professional		$143.91	$354.49	$443.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.18 / $106.74 / $138.66	Professional	26	$39.18	$106.74	$138.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $106.35 / $243.57 / $304.45	Professional	TC	$106.35	$243.57	$304.45
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $132.41 / $196.74 / $329.03	Professional		$132.41	$196.74	$329.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.32 / $63.61 / $111.98	Professional	26	$45.32	$63.61	$111.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $132.47 / $216.29	Professional	TC	$87.10	$132.47	$216.29
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $115.49 / $219.49 / $219.49	Facility	26	$115.49	$219.49	$219.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $144.51 / $219.28 / $1,019.78	Professional		$144.51	$219.28	$1,019.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.45 / $66.06 / $310.80	Professional	26	$38.45	$66.06	$310.80
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $93.77 / $127.80 / $708.98	Professional	TC	$93.77	$127.80	$708.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $107.56 / $110.70 / $272.16	Facility	26	$107.56	$110.70	$272.16
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.13 / $310.14 / $402.55	Professional		$181.13	$310.14	$402.55
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.73 / $135.68 / $250.19	Professional		$48.73	$135.68	$250.19
United Facility/Professional Professional Modifier Low / Median / High Price $144.51 / $180.64 / $333.76	Professional		$144.51	$180.64	$333.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.05 / $60.89 / $102.09	Professional	26	$43.05	$60.89	$102.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.77 / $122.11 / $207.98	Professional	TC	$93.77	$122.11	$207.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $203.90 / $258.10 / $303.60	Professional		$203.90	$258.10	$303.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $65.41 / $82.80 / $97.40	Professional	26	$65.41	$82.80	$97.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $138.49 / $175.30 / $206.20	Professional	TC	$138.49	$175.30	$206.20