Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $137.18 / $193.07 / $357.00	Facility	26	$137.18	$193.07	$357.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.87 / $275.00 / $430.29	Professional		$184.87	$275.00	$430.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $61.28 / $93.15	Professional	26	$55.00	$61.28	$93.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.95 / $173.69 / $354.04	Professional	TC	$123.95	$173.69	$354.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $212.01 / $218.37 / $224.73	Facility	26	$212.01	$218.37	$224.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.22 / $446.63 / $915.54	Professional		$275.22	$446.63	$915.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.31 / $135.75 / $202.99	Professional	26	$63.31	$135.75	$202.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $189.51 / $308.06 / $743.25	Professional	TC	$189.51	$308.06	$743.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $164.01 / $303.68 / $922.60	Professional		$164.01	$303.68	$922.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.62 / $94.96 / $276.82	Professional	26	$55.62	$94.96	$276.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.39 / $203.66 / $732.19	Professional	TC	$108.39	$203.66	$732.19
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $434.48 / $561.91 / $561.91	Facility	26	$434.48	$561.91	$561.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $209.66 / $379.62 / $2,075.08	Professional		$209.66	$379.62	$2,075.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.78 / $87.00 / $460.66	Professional	26	$66.78	$87.00	$460.66
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $141.31 / $242.98 / $1,685.33	Professional	TC	$141.31	$242.98	$1,685.33
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $218.37 / $224.73 / $332.94	Facility	26	$218.37	$224.73	$332.94
Midlands Facility/Professional Professional Modifier Low / Median / High Price $354.09 / $446.63 / $692.00	Professional		$354.09	$446.63	$692.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.65 / $173.58 / $306.83	Professional		$59.65	$173.58	$306.83
United Facility/Professional Professional Modifier Low / Median / High Price $200.01 / $248.20 / $434.57	Professional		$200.01	$248.20	$434.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.00 / $77.95 / $142.85	Professional	26	$64.00	$77.95	$142.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.31 / $184.38 / $890.32	Professional	TC	$141.31	$184.38	$890.32
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $283.93 / $359.40 / $422.80	Professional		$283.93	$359.40	$422.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $114.20 / $134.40	Professional	26	$90.22	$114.20	$134.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $193.63 / $245.10 / $288.39	Professional	TC	$193.63	$245.10	$288.39