Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.84 / $81.03 / $154.26	Facility	26	$43.84	$81.03	$154.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.93 / $159.16 / $639.00	Professional		$118.93	$159.16	$639.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $49.64 / $204.00	Professional	26	$42.60	$49.64	$204.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.28 / $94.48 / $209.09	Professional	TC	$76.28	$94.48	$209.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $149.28 / $153.76 / $158.24	Facility	26	$149.28	$153.76	$158.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.71 / $314.16 / $392.70	Professional		$144.71	$314.16	$392.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.14 / $107.82 / $134.78	Professional	26	$54.14	$107.82	$134.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.81 / $206.34 / $260.57	Professional	TC	$91.81	$206.34	$260.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $118.05 / $199.02 / $413.19	Professional		$118.05	$199.02	$413.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.98 / $71.15 / $166.82	Professional	26	$43.98	$71.15	$166.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.06 / $118.93 / $251.78	Professional	TC	$74.06	$118.93	$251.78
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $153.76 / $213.45 / $213.45	Facility	26	$153.76	$213.45	$213.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $135.41 / $220.63 / $872.98	Professional		$135.41	$220.63	$872.98
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $63.30 / $298.50	Professional	26	$48.61	$63.30	$298.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $84.76 / $108.03 / $574.48	Professional	TC	$84.76	$108.03	$574.48
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $153.76 / $158.24 / $263.52	Facility	26	$153.76	$158.24	$263.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $220.63 / $286.07 / $411.65	Professional		$220.63	$286.07	$411.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.43 / $113.79 / $224.79	Professional		$47.43	$113.79	$224.79
United Facility/Professional Professional Modifier Low / Median / High Price $131.57 / $157.88 / $303.61	Professional		$131.57	$157.88	$303.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $58.33 / $107.45	Professional	26	$48.61	$58.33	$107.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.96 / $101.46 / $190.64	Professional	TC	$82.96	$101.46	$190.64
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $188.26 / $238.30 / $280.39	Professional		$188.26	$238.30	$280.39
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $66.04 / $83.60 / $98.30	Professional	26	$66.04	$83.60	$98.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $122.21 / $154.69 / $182.00	Professional	TC	$122.21	$154.69	$182.00