Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.03 / $114.03 / $312.10	Facility	26	$114.03	$114.03	$312.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $174.03 / $275.00 / $467.42	Professional		$174.03	$275.00	$467.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $61.28 / $172.44	Professional	26	$55.00	$61.28	$172.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.02 / $183.73 / $282.38	Professional	TC	$114.02	$183.73	$282.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $190.23 / $195.94 / $201.64	Facility	26	$190.23	$195.94	$201.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.63 / $426.46 / $646.42	Professional		$216.63	$426.46	$646.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $136.52 / $186.91	Professional	26	$63.64	$136.52	$186.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.70 / $316.49 / $491.23	Professional	TC	$165.70	$316.49	$491.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $154.93 / $286.56 / $893.73	Professional		$154.93	$286.56	$893.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $90.77 / $207.53	Professional	26	$55.90	$90.77	$207.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.03 / $186.01 / $724.27	Professional	TC	$99.03	$186.01	$724.27
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $436.88 / $565.04 / $565.04	Facility	26	$436.88	$565.04	$565.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $197.07 / $348.53 / $1,897.57	Professional		$197.07	$348.53	$1,897.57
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.39 / $80.92 / $435.88	Professional	26	$63.39	$80.92	$435.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $128.71 / $221.38 / $1,600.00	Professional	TC	$128.71	$221.38	$1,600.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $195.94 / $201.64 / $334.74	Facility	26	$195.94	$201.64	$334.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $333.70 / $405.55 / $606.00	Professional		$333.70	$405.55	$606.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.98 / $163.52 / $289.87	Professional		$59.98	$163.52	$289.87
United Facility/Professional Professional Modifier Low / Median / High Price $188.00 / $233.29 / $408.46	Professional		$188.00	$233.29	$408.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.14 / $77.95 / $142.84	Professional	26	$62.14	$77.95	$142.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.09 / $155.04 / $292.52	Professional	TC	$124.09	$155.04	$292.52
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $267.64 / $338.80 / $398.60	Professional		$267.64	$338.80	$398.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.77 / $114.90 / $135.10	Professional	26	$90.77	$114.90	$135.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $176.96 / $224.00 / $263.50	Professional	TC	$176.96	$224.00	$263.50