Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.53 / $80.50 / $154.26	Facility	26	$43.53	$80.50	$154.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.59 / $146.07 / $650.00	Professional		$103.59	$146.07	$650.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.37 / $62.91 / $183.38	Professional	26	$42.37	$62.91	$183.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.22 / $80.73 / $188.10	Professional	TC	$61.22	$80.73	$188.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $146.96 / $151.37 / $155.78	Facility	26	$146.96	$151.37	$155.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.94 / $272.27 / $340.34	Professional		$112.94	$272.27	$340.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.54 / $107.05 / $139.74	Professional	26	$54.54	$107.05	$139.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.61 / $165.22 / $209.31	Professional	TC	$68.61	$165.22	$209.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $103.00 / $181.00 / $412.16	Professional		$103.00	$181.00	$412.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.70 / $73.78 / $151.02	Professional	26	$43.70	$73.78	$151.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.30 / $104.22 / $218.87	Professional	TC	$59.30	$104.22	$218.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $151.37 / $211.96 / $211.96	Facility	26	$151.37	$211.96	$211.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $120.97 / $185.32 / $757.96	Professional		$120.97	$185.32	$757.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $63.30 / $312.14	Professional	26	$48.61	$63.30	$312.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.93 / $88.34 / $470.82	Professional	TC	$69.93	$88.34	$470.82
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $151.37 / $155.78 / $261.72	Facility	26	$151.37	$155.78	$261.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $163.92 / $248.36 / $395.12	Professional		$163.92	$248.36	$395.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $108.68 / $193.99	Professional		$47.10	$108.68	$193.99
United Facility/Professional Professional Modifier Low / Median / High Price $118.28 / $149.41 / $264.75	Professional		$118.28	$149.41	$264.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.35 / $58.33 / $108.60	Professional	26	$48.35	$58.33	$108.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.93 / $80.56 / $153.04	Professional	TC	$69.93	$80.56	$153.04
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $163.44 / $206.90 / $243.40	Professional		$163.44	$206.90	$243.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $65.56 / $83.00 / $97.60	Professional	26	$65.56	$83.00	$97.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $97.88 / $123.90 / $145.80	Professional	TC	$97.88	$123.90	$145.80