Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.47 / $139.08 / $257.50	Facility	26	$75.47	$139.08	$257.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.10 / $180.10 / $1,512.03	Professional		$180.10	$180.10	$1,512.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.66 / $141.66 / $1,248.58	Professional	TC	$141.66	$141.66	$1,248.58
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $136.49 / $140.58 / $144.68	Facility	26	$136.49	$140.58	$144.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $435.51 / $480.16 / $600.20	Professional		$435.51	$480.16	$600.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $344.43 / $382.42 / $478.03	Professional	TC	$344.43	$382.42	$478.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $177.36 / $306.92 / $776.11	Professional		$177.36	$306.92	$776.11
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.02 / $65.67 / $158.07	Professional	26	$40.02	$65.67	$158.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.35 / $242.18 / $585.41	Professional	TC	$137.35	$242.18	$585.41
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $140.58 / $140.58 / $140.58	Facility	26	$140.58	$140.58	$140.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $217.05 / $338.87 / $869.76	Professional		$217.05	$338.87	$869.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $166.40 / $199.68 / $857.99	Professional	TC	$166.40	$199.68	$857.99
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $140.58 / $144.68 / $238.38	Facility	26	$140.58	$144.68	$238.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $383.28 / $460.35 / $635.92	Professional		$383.28	$460.35	$635.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.89 / $187.60 / $584.92	Professional		$42.89	$187.60	$584.92
United Facility/Professional Professional Modifier Low / Median / High Price $210.86 / $242.49 / $423.26	Professional		$210.86	$242.49	$423.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.40 / $191.36 / $339.07	Professional	TC	$166.40	$191.36	$339.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $276.02 / $349.40 / $411.10	Professional		$276.02	$349.40	$411.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $218.28 / $276.30 / $325.10	Professional	TC	$218.28	$276.30	$325.10