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 $150.72 / $245.75 / $924.61	Professional		$150.72	$245.75	$924.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $62.63 / $301.00	Professional	26	$55.15	$62.63	$301.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.04 / $173.55 / $221.14	Professional	TC	$90.04	$173.55	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $189.33 / $195.01 / $200.69	Facility	26	$189.33	$195.01	$200.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $205.50 / $360.72 / $613.67	Professional		$205.50	$360.72	$613.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.31 / $138.07 / $197.82	Professional	26	$64.31	$138.07	$197.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.97 / $220.61 / $457.06	Professional	TC	$136.97	$220.61	$457.06
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $134.82 / $248.93 / $661.52	Professional		$134.82	$248.93	$661.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.51 / $91.74 / $241.59	Professional	26	$56.51	$91.74	$241.59
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.31 / $147.26 / $488.78	Professional	TC	$78.31	$147.26	$488.78
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $441.84 / $568.24 / $568.24	Facility	26	$441.84	$568.24	$568.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $170.09 / $298.43 / $1,403.43	Professional		$170.09	$298.43	$1,403.43
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $64.08 / $81.81 / $384.88	Professional	26	$64.08	$81.81	$384.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $100.99 / $169.45 / $1,332.00	Professional	TC	$100.99	$169.45	$1,332.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $195.01 / $200.69 / $336.72	Facility	26	$195.01	$200.69	$336.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $289.00 / $360.72 / $517.37	Professional		$289.00	$360.72	$517.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.65 / $116.86 / $251.79	Professional		$60.65	$116.86	$251.79
United Facility/Professional Professional Modifier Low / Median / High Price $162.36 / $201.36 / $352.56	Professional		$162.36	$201.36	$352.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.92 / $81.81 / $144.44	Professional	26	$62.92	$81.81	$144.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.21 / $127.25 / $212.38	Professional	TC	$98.21	$127.25	$212.38
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $231.71 / $293.30 / $345.00	Professional		$231.71	$293.30	$345.00
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 $139.91 / $177.10 / $208.40	Professional	TC	$139.91	$177.10	$208.40