Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.59 / $130.65 / $241.66	Facility	26	$75.59	$130.65	$241.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $199.24 / $702.02	Professional		$52.52	$199.24	$702.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $58.96 / $226.61	Professional	26	$36.49	$58.96	$226.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $140.28 / $475.35	Professional	TC	$16.03	$140.28	$475.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $131.16 / $135.09 / $139.03	Facility	26	$131.16	$135.09	$139.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.24 / $322.69 / $403.36	Professional		$201.24	$322.69	$403.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.94 / $92.31 / $115.39	Professional	26	$78.94	$92.31	$115.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.04 / $230.38 / $287.98	Professional	TC	$120.04	$230.38	$287.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.62 / $161.19 / $310.14	Professional		$119.62	$161.19	$310.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.06 / $60.44 / $110.63	Professional	26	$37.06	$60.44	$110.63
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.41 / $109.58 / $184.33	Professional	TC	$70.41	$109.58	$184.33
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $135.09 / $135.09 / $135.09	Facility	26	$135.09	$135.09	$135.09
Medica Facility/Professional Professional Modifier Low / Median / High Price $100.52 / $170.16 / $465.29	Professional		$100.52	$170.16	$465.29
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.88 / $52.89 / $414.43	Professional	26	$42.88	$52.89	$414.43
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.91 / $96.96 / $639.54	Professional	TC	$46.91	$96.96	$639.54
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $135.09 / $139.03 / $219.42	Facility	26	$135.09	$139.03	$219.42
Midlands Facility/Professional Professional Modifier Low / Median / High Price $113.78 / $253.41 / $369.90	Professional		$113.78	$253.41	$369.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.18 / $127.30 / $227.23	Professional		$40.18	$127.30	$227.23
United Facility/Professional Professional Modifier Low / Median / High Price $88.73 / $143.65 / $233.08	Professional		$88.73	$143.65	$233.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.88 / $50.76 / $82.99	Professional	26	$42.88	$50.76	$82.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.91 / $89.35 / $143.71	Professional	TC	$46.91	$89.35	$143.71
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $200.11 / $253.30 / $298.00	Professional		$200.11	$253.30	$298.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $58.46 / $74.00 / $87.00	Professional	26	$58.46	$74.00	$87.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $141.65 / $179.30 / $211.00	Professional	TC	$141.65	$179.30	$211.00