Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $342.01 / $342.01 / $342.01	Facility	26	$342.01	$342.01	$342.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.07 / $290.22 / $889.00	Professional		$198.07	$290.22	$889.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.42 / $154.25 / $414.95	Professional	26	$119.42	$154.25	$414.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.65 / $101.62 / $209.39	Professional	TC	$78.65	$101.62	$209.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $372.67 / $484.50 / $558.15	Professional		$372.67	$484.50	$558.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $221.48 / $281.87 / $333.25	Professional	26	$221.48	$281.87	$333.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $142.11 / $196.38 / $233.51	Professional	TC	$142.11	$196.38	$233.51
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.81 / $288.86 / $868.43	Professional		$186.81	$288.86	$868.43
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $119.56 / $183.75 / $502.75	Professional	26	$119.56	$183.75	$502.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.23 / $102.38 / $293.35	Professional	TC	$67.23	$102.38	$293.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $292.77 / $494.03 / $1,374.92	Professional		$292.77	$494.03	$1,374.92
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $170.60 / $301.23 / $824.31	Professional	26	$170.60	$301.23	$824.31
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $112.06 / $197.42 / $550.61	Professional	TC	$112.06	$197.42	$550.61
Midlands Facility/Professional Professional Modifier Low / Median / High Price $349.76 / $461.12 / $590.12	Professional		$349.76	$461.12	$590.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $80.87 / $194.71 / $374.93	Professional		$80.87	$194.71	$374.93
United Facility/Professional Professional Modifier Low / Median / High Price $251.95 / $477.99 / $595.92	Professional		$251.95	$477.99	$595.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.27 / $262.55 / $357.79	Professional	26	$151.27	$262.55	$357.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.68 / $181.28 / $262.64	Professional	TC	$100.68	$181.28	$262.64
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $328.40 / $415.70 / $489.10	Professional		$328.40	$415.70	$489.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $203.50 / $257.60 / $303.00	Professional	26	$203.50	$257.60	$303.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $124.90 / $158.10 / $186.00	Professional	TC	$124.90	$158.10	$186.00