Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.15 / $170.27 / $256.50	Facility		$59.15	$170.27	$256.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.78 / $48.37 / $48.37	Facility	26	$16.78	$48.37	$48.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.85 / $90.91 / $174.55	Professional		$61.85	$90.91	$174.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.72 / $21.54 / $48.37	Professional	26	$16.72	$21.54	$48.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.83 / $65.01 / $154.11	Professional	TC	$43.83	$65.01	$154.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.22 / $174.48 / $337.38	Professional		$127.22	$174.48	$337.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $42.16 / $56.62	Professional	26	$32.00	$42.16	$56.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.38 / $127.31 / $270.64	Professional	TC	$90.38	$127.31	$270.64
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $57.58 / $91.86 / $208.48	Professional		$57.58	$91.86	$208.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.72 / $27.02 / $56.92	Professional	26	$16.72	$27.02	$56.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.86 / $71.95 / $159.15	Professional	TC	$40.86	$71.95	$159.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $78.09 / $144.50 / $338.21	Facility		$78.09	$144.50	$338.21
Medica Facility/Professional Professional Modifier Low / Median / High Price $84.81 / $165.04 / $803.55	Professional		$84.81	$165.04	$803.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $23.10 / $42.81 / $416.07	Professional	26	$23.10	$42.81	$416.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $66.01 / $115.46 / $567.25	Professional	TC	$66.01	$115.46	$567.25
Midlands Facility/Professional Facility Modifier Low / Median / High Price $130.40 / $156.66 / $197.98	Facility		$130.40	$156.66	$197.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $126.07 / $162.80 / $250.38	Professional		$126.07	$162.80	$250.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $18.55 / $63.33 / $117.37	Professional		$18.55	$63.33	$117.37
United Facility/Professional Professional Modifier Low / Median / High Price $71.70 / $141.52 / $244.62	Professional		$71.70	$141.52	$244.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.10 / $39.19 / $49.91	Professional	26	$21.10	$39.19	$49.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.61 / $99.24 / $226.05	Professional	TC	$50.61	$99.24	$226.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.36 / $132.10 / $155.40	Professional		$104.36	$132.10	$155.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $28.44 / $36.00 / $42.40	Professional	26	$28.44	$36.00	$42.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $75.92 / $96.10 / $113.00	Professional	TC	$75.92	$96.10	$113.00