Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.17 / $115.29 / $313.91	Facility	26	$56.17	$115.29	$313.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.97 / $259.57 / $1,009.94	Professional		$158.97	$259.57	$1,009.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $64.83 / $282.73	Professional	26	$55.15	$64.83	$282.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.30 / $177.61 / $310.11	Professional	TC	$98.30	$177.61	$310.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $191.37 / $197.11 / $202.85	Facility	26	$191.37	$197.11	$202.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $254.76 / $393.16 / $760.34	Professional		$254.76	$393.16	$760.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.31 / $138.07 / $188.01	Professional	26	$64.31	$138.07	$188.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $166.23 / $265.14 / $602.29	Professional	TC	$166.23	$265.14	$602.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $142.49 / $263.10 / $685.69	Professional		$142.49	$263.10	$685.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.51 / $91.74 / $213.26	Professional	26	$56.51	$91.74	$213.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.98 / $161.43 / $488.78	Professional	TC	$85.98	$161.43	$488.78
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $441.84 / $571.36 / $571.36	Facility	26	$441.84	$571.36	$571.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $207.74 / $344.43 / $1,670.68	Professional		$207.74	$344.43	$1,670.68
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.76 / $81.39 / $520.49	Professional	26	$63.76	$81.39	$520.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $137.71 / $221.17 / $1,318.41	Professional	TC	$137.71	$221.17	$1,318.41
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $197.11 / $202.85 / $338.52	Facility	26	$197.11	$202.85	$338.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $305.91 / $379.11 / $547.96	Professional		$305.91	$379.11	$547.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.65 / $116.86 / $266.61	Professional		$60.65	$116.86	$266.61
United Facility/Professional Professional Modifier Low / Median / High Price $203.55 / $244.41 / $433.33	Professional		$203.55	$244.41	$433.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $75.79 / $142.01	Professional	26	$62.50	$75.79	$142.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.44 / $163.05 / $298.07	Professional	TC	$131.44	$163.05	$298.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $245.37 / $310.60 / $365.40	Professional		$245.37	$310.60	$365.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $91.80 / $116.20 / $136.69	Professional	26	$91.80	$116.20	$136.69
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $153.66 / $194.50 / $228.80	Professional	TC	$153.66	$194.50	$228.80