Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.39 / $101.44 / $337.53	Facility	26	$49.39	$101.44	$337.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.75 / $275.00 / $409.21	Professional		$180.75	$275.00	$409.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.39 / $63.16 / $233.61	Professional	26	$53.39	$63.16	$233.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.49 / $176.31 / $334.93	Professional	TC	$126.49	$176.31	$334.93
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $205.71 / $211.88 / $218.05	Facility	26	$205.71	$211.88	$218.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.56 / $435.02 / $881.37	Professional		$295.56	$435.02	$881.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.08 / $122.31 / $181.41	Professional	26	$60.08	$122.31	$181.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.10 / $316.75 / $711.93	Professional	TC	$214.10	$316.75	$711.93
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $160.32 / $297.35 / $811.27	Professional		$160.32	$297.35	$811.27
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $49.66 / $89.41 / $195.04	Professional	26	$49.66	$89.41	$195.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.66 / $207.93 / $586.92	Professional	TC	$110.66	$207.93	$586.92
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $502.08 / $502.08	Facility	26	$388.00	$502.08	$502.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $230.92 / $390.68 / $1,940.92	Professional		$230.92	$390.68	$1,940.92
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.82 / $80.84 / $556.79	Professional	26	$60.82	$80.84	$556.79
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $168.68 / $260.83 / $1,561.11	Professional	TC	$168.68	$260.83	$1,561.11
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $211.88 / $218.05 / $297.66	Facility	26	$211.88	$218.05	$297.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $351.11 / $510.42 / $641.94	Professional		$351.11	$510.42	$641.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.43 / $169.21 / $299.83	Professional		$53.43	$169.21	$299.83
United Facility/Professional Professional Modifier Low / Median / High Price $219.07 / $272.39 / $495.45	Professional		$219.07	$272.39	$495.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.74 / $72.00 / $153.50	Professional	26	$57.74	$72.00	$153.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $168.68 / $203.11 / $364.94	Professional	TC	$168.68	$203.11	$364.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $278.32 / $352.30 / $414.50	Professional		$278.32	$352.30	$414.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $80.58 / $102.00 / $120.00	Professional	26	$80.58	$102.00	$120.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $197.74 / $250.30 / $294.39	Professional	TC	$197.74	$250.30	$294.39