Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.49 / $95.99 / $177.08	Facility	26	$56.49	$95.99	$177.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.22 / $90.81 / $117.41	Professional		$77.22	$90.81	$117.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.85 / $63.47 / $86.27	Professional	TC	$51.85	$63.47	$86.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.83 / $97.67 / $100.52	Facility	26	$94.83	$97.67	$100.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.88 / $206.34 / $271.95	Professional		$95.88	$206.34	$271.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.34 / $143.50 / $179.38	Professional	TC	$70.34	$143.50	$179.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $77.26 / $125.27 / $208.57	Professional		$77.26	$125.27	$208.57
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.60 / $41.70 / $61.50	Professional	26	$25.60	$41.70	$61.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.65 / $78.30 / $155.21	Professional	TC	$51.65	$78.30	$155.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $97.67 / $124.11 / $124.11	Facility	26	$97.67	$124.11	$124.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $94.29 / $148.94 / $673.71	Professional		$94.29	$148.94	$673.71
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.04 / $94.31 / $514.25	Professional	TC	$61.04	$94.31	$514.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $97.67 / $100.52 / $153.60	Facility	26	$97.67	$100.52	$153.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $139.00 / $187.86 / $271.95	Professional		$139.00	$187.86	$271.95
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.52 / $78.86 / $145.16	Professional		$27.52	$78.86	$145.16
United Facility/Professional Professional Modifier Low / Median / High Price $90.92 / $118.40 / $185.16	Professional		$90.92	$118.40	$185.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.04 / $79.48 / $134.00	Professional	TC	$61.04	$79.48	$134.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $119.05 / $150.69 / $177.30	Professional		$119.05	$150.69	$177.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $82.08 / $103.90 / $122.20	Professional	TC	$82.08	$103.90	$122.20