Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.87 / $193.48 / $355.09	Facility	26	$99.87	$193.48	$355.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.71 / $166.23 / $299.29	Professional		$141.71	$166.23	$299.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.42 / $80.34 / $148.76	Professional	26	$60.42	$80.34	$148.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.36 / $75.98 / $232.83	Professional	TC	$61.36	$75.98	$232.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $197.18 / $203.10 / $209.01	Facility	26	$197.18	$203.10	$209.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $206.55 / $398.43 / $616.53	Professional		$206.55	$398.43	$616.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.16 / $200.91 / $251.13	Professional	26	$75.16	$200.91	$251.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.10 / $182.55 / $455.63	Professional	TC	$113.10	$182.55	$455.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $146.26 / $264.20 / $867.41	Professional		$146.26	$264.20	$867.41
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $85.53 / $117.91 / $298.63	Professional	26	$85.53	$117.91	$298.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.73 / $113.85 / $753.03	Professional	TC	$60.73	$113.85	$753.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.91 / $413.29 / $413.29	Facility	26	$213.91	$413.29	$413.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $181.12 / $320.95 / $3,140.08	Professional		$181.12	$320.95	$3,140.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $75.45 / $119.82 / $681.88	Professional	26	$75.45	$119.82	$681.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $79.90 / $136.82 / $2,808.09	Professional	TC	$79.90	$136.82	$2,808.09
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $203.10 / $209.01 / $496.86	Facility	26	$203.10	$209.01	$496.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $303.38 / $402.14 / $817.00	Professional		$303.38	$402.14	$817.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.87 / $142.06 / $278.95	Professional		$72.87	$142.06	$278.95
United Facility/Professional Professional Modifier Low / Median / High Price $169.37 / $214.41 / $406.69	Professional		$169.37	$214.41	$406.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.13 / $110.41 / $193.04	Professional	26	$83.13	$110.41	$193.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.64 / $95.16 / $252.25	Professional	TC	$72.64	$95.16	$252.25
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $219.70 / $278.10 / $327.10	Professional		$219.70	$278.10	$327.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $123.16 / $155.90 / $183.40	Professional	26	$123.16	$155.90	$183.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $96.54 / $122.20 / $143.69	Professional	TC	$96.54	$122.20	$143.69