Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.48 / $39.72 / $119.50	Facility	26	$21.48	$39.72	$119.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $191.53 / $258.89 / $1,303.00	Professional		$191.53	$258.89	$1,303.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.91 / $22.39 / $69.97	Professional	26	$20.91	$22.39	$69.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.62 / $183.83 / $608.91	Professional	TC	$170.62	$183.83	$608.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.69 / $74.87 / $77.05	Facility	26	$72.69	$74.87	$77.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $456.15 / $504.98 / $631.23	Professional		$456.15	$504.98	$631.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.10 / $52.75 / $65.93	Professional	26	$49.10	$52.75	$65.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $407.04 / $452.23 / $565.29	Professional	TC	$407.04	$452.23	$565.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $183.90 / $287.14 / $859.95	Professional		$183.90	$287.14	$859.95
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.59 / $33.11 / $81.00	Professional	26	$21.59	$33.11	$81.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.31 / $277.76 / $593.86	Professional	TC	$162.31	$277.76	$593.86
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $74.87 / $74.87 / $74.87	Facility	26	$74.87	$74.87	$74.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $225.01 / $293.01 / $734.34	Professional		$225.01	$293.01	$734.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $23.92 / $27.85 / $85.61	Professional	26	$23.92	$27.85	$85.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $201.09 / $241.31 / $786.38	Professional	TC	$201.09	$241.31	$786.38
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $74.87 / $77.05 / $128.28	Facility	26	$74.87	$77.05	$128.28
Midlands Facility/Professional Professional Modifier Low / Median / High Price $391.65 / $478.60 / $640.23	Professional		$391.65	$478.60	$640.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.30 / $195.37 / $436.29	Professional		$23.30	$195.37	$436.29
United Facility/Professional Professional Modifier Low / Median / High Price $225.01 / $258.76 / $434.27	Professional		$225.01	$258.76	$434.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.92 / $27.51 / $78.02	Professional	26	$23.92	$27.51	$78.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $201.09 / $241.31 / $409.83	Professional	TC	$201.09	$241.31	$409.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $289.14 / $366.00 / $430.60	Professional		$289.14	$366.00	$430.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $39.40 / $46.30	Professional	26	$31.13	$39.40	$46.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $258.01 / $326.60 / $384.20	Professional	TC	$258.01	$326.60	$384.20