Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.58 / $70.58 / $70.58	Facility	26	$70.58	$70.58	$70.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.47 / $200.85 / $270.13	Professional		$183.47	$200.85	$270.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.27 / $50.01 / $79.41	Professional	26	$45.27	$50.01	$79.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.50 / $150.83 / $208.75	Professional	TC	$136.50	$150.83	$208.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $156.08 / $160.76 / $165.44	Facility	26	$156.08	$160.76	$165.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $217.08 / $476.28 / $643.73	Professional		$217.08	$476.28	$643.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.10 / $118.68 / $158.53	Professional	26	$52.10	$118.68	$158.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $168.63 / $357.60 / $485.20	Professional	TC	$168.63	$357.60	$485.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.45 / $274.89 / $1,061.21	Professional		$199.45	$274.89	$1,061.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.12 / $74.42 / $276.83	Professional	26	$53.12	$74.42	$276.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.97 / $200.46 / $663.80	Professional	TC	$147.97	$200.46	$663.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $122.98 / $234.66 / $234.66	Facility	26	$122.98	$234.66	$234.66
Medica Facility/Professional Professional Modifier Low / Median / High Price $227.88 / $379.26 / $1,374.92	Professional		$227.88	$379.26	$1,374.92
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $81.81 / $330.16	Professional	26	$56.48	$81.81	$330.16
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.43 / $243.27 / $1,044.76	Professional	TC	$169.43	$243.27	$1,044.76
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $160.76 / $165.44 / $289.98	Facility	26	$160.76	$165.44	$289.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $391.02 / $431.95 / $687.19	Professional		$391.02	$431.95	$687.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $271.20 / $271.20 / $271.20	Professional		$271.20	$271.20	$271.20
United Facility/Professional Professional Modifier Low / Median / High Price $227.56 / $325.08 / $655.45	Professional		$227.56	$325.08	$655.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.48 / $81.81 / $162.16	Professional	26	$56.48	$81.81	$162.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $170.06 / $243.27 / $537.22	Professional	TC	$170.06	$243.27	$537.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $357.00 / $451.90 / $531.60	Professional		$357.00	$451.90	$531.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $91.17 / $115.40 / $135.69	Professional	26	$91.17	$115.40	$135.69
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $265.83 / $336.50 / $395.90	Professional	TC	$265.83	$336.50	$395.90